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Excision
Kinds of Excision Terms modified by Excision Selected AbstractsGS13P OUTCOME OF TRANS-ANAL EXCISION FOR RECTAL CANCERANZ JOURNAL OF SURGERY, Issue 2007S. Banerjee Aims The aim of this study is to assess the outcome of trans-anal excision of rectal cancer in a single Surgeon's practice and determine possible selection criteria for this procedure. Methods Retrospective review of hospital records, specimen histopathology and imaging of consecutive patients with rectal cancer undergoing trans-anal excision as the primary treatment. Results 25 patients had trans-anal excision of rectal cancer including 3 cases of carcinoid tumour and 1 case of gastro-intestinal stromal tumour (GIST). 5/25 proceeded to radical rectal resection because of the presence of adverse features including lympho-vascular and peri-neural invasion and poorly differentiated cell type; residual tumour was present in 4/5 cases, nodal metastases in 3/5 patients each of whom received pre-operative chemotherapy and radiotherapy. 2/25 patients developed recurrence at 12 and 48 months from excision. One of these patients had distant recurrence at 12 months having proceeded to radical rectal resection and the other patient (aged 99), managed with trans-anal excision alone, recurred locally at 48 months. Both cases of recurrence were T3 tumours. Overall, 19/20 cases managed with trans-anal excision alone had no recurrence with a follow-up period of 12,48 months. 16 of these patients had T1 malignancy. Conclusion T1 tumours may be treated with trans-excision alone in the absence of adverse pathological features. It is unclear from our study whether T2 should be managed in this way due to their small number in this study and T3 tumours are clearly at high risk of recurrence with this treatment alone. [source] VESSEL-SPARING EXCISION AND PRIMARY ANASTOMOSIS (FOR PROXIMAL BULBAR URETHRAL STRICTURES)BJU INTERNATIONAL, Issue 6 2008Robert Whitaker No abstract is available for this article. [source] Sentinel Lymph Node Excision and PET-CT in the Initial Stage of Malignant Melanoma: A Retrospective Analysis of 61 Patients with Malignant Melanoma in American Joint Committee on Cancer Stages I and IIDERMATOLOGIC SURGERY, Issue 4 2010JOACHIM KLODE MD BACKGROUND AND OBJECTIVES Sentinel lymph node excision (SLNE) for the detection of regional nodal metastases and staging of malignant melanoma has resulted in some controversies in international discussions. Positron emission tomography with computerized tomography (PET-CT), a noninvasive imaging procedure for the detection of regional nodal metastases, has increasingly become of interest. Our study is a direct comparison of SLNE and PET-CT in patients with early-stage malignant melanoma. MATERIALS AND METHODS We retrospectively analyzed data from 61 patients with primary malignant melanoma with a Breslow index greater than 1.0 mm. RESULTS Metastatic SLNs were found in 14 patients (23%); 17 metastatic lymph nodes were detected overall, only one of which was identified preoperatively using PET-CT. Thus, PET-CT showed a sensitivity of 5.9% and a negative predictive value of 78%. CONCLUSION SLNE is much more sensitive than PET-CT in discovering small lymph node metastases. We consider PET-CT unsuitable for the evaluation of early regional lymphatic tumor dissemination in this patient population and recommend that it be limited to malignant melanomas of American Joint Committee on Cancer stages III and IV. We therefore recommend the routine use of SLNE for tumor staging and stratification for adjuvant therapy of patients with stage I and II malignant melanoma. The authors have indicated no significant interest with commercial supporters. [source] Small and Medium-Sized Congenital Nevi in Children: A Comparison of the Costs of Excision and Long-Term Follow-UpDERMATOLOGIC SURGERY, Issue 12 2009FERNANDO ALFAGEME ROLDÁN MD BACKGROUND Clinical decisions on whether to follow up or remove small and medium congenital melanocytic nevi (SMCMN) in children have cost implications that have not been studied. OBJECTIVES To compare the costs of excision of SMCMN in children with lifelong follow-up in a tertiary center. METHODS AND MATERIALS We elaborated models for the evaluation of the costs of excision and long-term follow-up. We retrospectively collected data on 113 consecutive excised SMCMN (105 single-step interventions and 8 multiple-step interventions) from the medical records of our pediatric dermatology unit from 2001 to 2007 and calculated and compared the costs (direct and indirect) of surgery and follow-up. RESULTS The mean ± standard deviation and total cohort costs for single-step interventions were ,1,504.73 ± 198.33 and 157,996.20, respectively. Median and cohort lifelong follow-up costs were similar if performed every 4 years (1,482.66 ± 34.98 and 156,679.63). For multiple-step interventions (3 or 4 steps), surgery costs were similar to those of annual lifelong follow-up. In the case of two-step surgery, costs were similar to lifelong follow-up every 2 years. CONCLUSIONS An analysis of the costs of surgery and long-term follow-up in children with SMCMN is possible. Although the clinical judgment of the dermatologist and parental opinion are the main determinants in the management of SMCMN, costs should also be taken into account. [source] Cerclage Technique for Repairing Large Circular Defects of the Trunk: Two-Staged Excision of a Plexiform NeurofibromaDERMATOLOGIC SURGERY, Issue 7 2008TONY N. NAKHLA DO First page of article [source] Treatment of Lentigo Maligna with Imiquimod before Staged ExcisionDERMATOLOGIC SURGERY, Issue 2 2008MURRAY A. COTTER MD BACKGROUND Imiquimod 5% cream has demonstrated effectiveness in the treatment of lentigo maligna (LM) in several small studies. None of the studies to date have included posttreatment surgical removal to confirm negative histologic margins. OBJECTIVE The aim of this retrospective analysis was to assess the efficacy of topical imiquimod in LM by circumferentially examining vertically oriented sections from a geometrically designed "picture frame" margin as well as bread-loafed sections of the central portion after staged excisions of imiquimod-treated lesions of LM. METHODS Forty patients with biopsy-confirmed LM were treated five times a week for 3 months with 5% imiquimod cream before staged excision. Tazarotene 0.1% gel was added when no clinical signs of erythema developed with imiquimod alone after 1 month (10 patients). After the course of topical therapy, patients were assessed for clinical and complete histologic clearance after staged excision. RESULTS A total of 33 of 40 patients had a complete clinical response as determined by the absence of remaining clinical lesion on physical examination. Upon histologic review, 30 of 40 patients had no evidence of LM whereas 10 of 40 harbored residual disease. One patient was found to have histologic evidence of invasion after completing the topical protocol. After a mean follow-up of 18 months (range, 12,34 months) and after complete surgical excision of the treatment site, none of the imiquimod-treated patients had evidence of recurrence. CONCLUSIONS Imiquimod appears to be an effective adjunctive treatment for LM but does not qualify as a replacement therapy for surgery. [source] Letter: Nipple Asymmetry Resulting from Lesion Excision and Use of a Purse-String SutureDERMATOLOGIC SURGERY, Issue 8 2007FIACS, LAWRENCE M. FIELD MD No abstract is available for this article. [source] Tragus Reconstruction after Tumor Excision with Preauricular Folded FlapDERMATOLOGIC SURGERY, Issue 6 2007NETA ADLER MD First page of article [source] T- and B-Cutaneous Pseudolymphomas Treated by Surgical Excision and Immediate ReconstructionDERMATOLOGIC SURGERY, Issue 12 2006ALEXANDER DIONYSSOPOULOS MD First page of article [source] Squamous Cell Carcinoma Arising Within a Facial Port-Wine Stain Treated by Mohs Micrographic Surgical ExcisionDERMATOLOGIC SURGERY, Issue 6 2006NEIL RAJAN MRCP No abstract is available for this article. [source] Giant Multilocular Epidermoid Cyst on the Left ButtockDERMATOLOGIC SURGERY, Issue 10 2005Alexandros Polychronidis MD Background. Epidermoid cysts are the most common cysts of the skin. They are generally small and slow-growing and rarely reach more than 5 cm in diameter. Objective. We present a patient with a giant multilocular epidermoid cyst. Methods. A 75-year-old man presented with a giant, soft, painless, tumorlike mass on the left buttock that had gradually enlarged over a 12-year period. Excision of the mass from the surrounding tissue was extremely easy because of a well-defined capsule. Results. The 28 3 14 3 12 cm mass was totally excised. A histopathologic examination revealed that it was an epidermoid cyst. Conclusion. This rare case of giant epidermoid cyst was treated successfully by local excision followed by primary closure. Dissection of the mass from the surrounding tissue was extremely easy because of a well-defined capsule. [source] Patients Spend More Time With the Physician for Excision of a Malignant Skin Lesion Than for Excision of a Benign Skin LesionDERMATOLOGIC SURGERY, Issue 3 2004Steven R. Feldman MD Background. Currently, there is a difference in reimbursement between excision of malignant and benign lesions. There is concern that there is not sufficient rationale for differential reimbursement for these two procedures. Objective. To assess whether there is a difference in physician work involved with excision of benign versus malignant skin tumors. Method. We searched National Ambulatory Medical Care Survey data for visits at which excision of benign and malignant skin lesions was performed. We compared the time spent with the physician at these two types of visits. To exclude confounding issues unrelated to the excision that would affect the time of visit, we excluded visits at which multiple diagnoses were addressed. Results. The mean time spent with the physician at visits for excision of benign lesions was 22.9±1.0 minutes. The mean time spent with the physician at visits for excision of malignant lesions was 30.0±1.7, 30% longer (p < 0.001). The longer time for excision of malignant lesions remained significant after controlling for age, gender, and race. Conclusion. Excision of malignant lesions involves more physician work than does excision of benign lesions. Elimination of differential compensation for benign versus malignant skin lesion procedures would not enhance the accuracy of reimbursement. In the absence of any compelling rationale to change the existing differential reimbursement, the proposals to do so are not warranted. [source] Repair of a Large Wound of the Back, Post-Mohs Micrographical Excision, Using Chronic Skin ExpansionDERMATOLOGIC SURGERY, Issue 6 2003Ron M. Shelton MD Background. Large defects not otherwise closed primarily may be closed after chronic skin expansion. Objective. If chronic expansion were deemed indicated for the closure of a proposed defect expected to result from Mohs micrographic surgery, can it be performed before Mohs surgery, avoiding the increased chance of expander extrusion via the defect when done postoperatively? Methods. A team approach of a Mohs surgeon and a plastic surgeon coordinated scheduling an insertion of and staged infiltration of a tissue expander before Mohs surgical removal of a large basal cell carcinoma on the back of a young woman. The reconstruction after Mohs surgery was scheduled for the immediate postoperative period. Results. The Mohs surgery completed removed the carcinoma, and the expander was removed, enabling the surgeon to perform a side-to-side closure. Conclusion. Provided that there is not a great probability of the neoplasm extending significantly deeper or wider than expected and that the skin expander is placed so as not to disturb the plane of Mohs excision, this is a useful technique to close large Mohs defects. [source] The Efficacy of Electrosurgery and Excision in Treating Patients with Multiple Apocrine HidrocystomasDERMATOLOGIC SURGERY, Issue 4 2001Somesh Gupta MD Background. Apocrine hidrocystomas are adenomatous cystic proliferations of the apocrine glands. They typically occur as solitary lesions, though rarely may occur as multiple lesions. Management of multiple hidrocystomas can be difficult, particularly if they are large. Surgical modalities may be required for effective therapy. Objective. To compare the results of electrosurgery and excision in treating multiple apocrine hidrocystomas. Methods. A 50-year-old man presented with multiple apocrine hidrocystomas ranging in size from 1 to 12 mm. The lesions were located over the periorbital skin, cheeks, and pinnae. Excision and electrodessication were utilized for therapy. At a 1-year follow-up, the patient was evaluated for recurrences and cosmetic result. Results. There were no recurrences until 1 year after surgery. In the areas treated with electrodessication, no visible scars were identified. In the areas treated with excision, localized scars were observed. Conclusions. Both electrodessiation and excision are effective therapies for multiple apocrine hidrocystomas. We suggest that tumors less than 1 cm be treated with electrodessication and lesions greater than 1 cm with excision. [source] Mohs Micrographic Excision of Melanoma Using ImmunostainsDERMATOLOGIC SURGERY, Issue 8 2000Mark J. Zalla MD Background. Mohs excision of melanoma remains controversial, in part because of concerns regarding evaluation of frozen section margins. Several immunohistochemical stains are available for melanoma that can be used on frozen sections. Objective. To review our experience with Mohs micrographic excision of melanoma using immunostains. Methods. Sixty-eight patients were treated, including 46 with melanoma in situ and 22 with invasive melanoma, 62 of which were on the head or neck. HMB-45, MEL-5, Melan-A (A-103), and S-100 stains were employed. Results. Sixty-seven of 68 tumors were excised to clear margins, requiring an average of 2.0 layers. Immunostains greatly enhanced detection of melanoma on frozen sections. The average margin required for clearance of in situ melanoma was 8.3 mm and of invasive melanoma was 11.1 mm. Only 23 of 46 (50%) in situ melanomas were clear with ,6 mm margins; 15 mm margins were required to clear 96% of the tumors. Eleven of 22 (50%) invasive melanomas were clear with ,6 mm margins; 26 mm margins were required to clear 95% of the tumors. Melan-A (A-103) was the most consistently crisp and easily interpreted immunostain. Conclusions. Mohs excision of melanoma using immunostains can be useful, especially for tumors on the head and neck. For routine excision, margins wider than those currently recommended may be required to ensure tumor clearance. We recommend that (1) biopsies be stained preoperatively for Melan-A and/or HMB-45, (2) a debulking layer be obtained for permanent sections prior to Mohs layers, and positive and negative control specimens from the tumor and distant skin should be employed for comparison of staining patterns. Large-scale prospective studies of in situ and invasive melanoma on the head and neck are necessary. [source] Expression and characterization of ,-glucosidase III in the dwarf honeybee, Apis florea (Hymenoptera: Apoidea: Apidae)INSECT SCIENCE, Issue 4 2007CHANPEN CHANCHAO Abstract Alpha-glucosidase is synthesized in the hypopharyngeal glands located in the head of worker bees including Apis florea. To analyze the developmental stage-specific expression of the ,-glucosidase gene in A. florea, total RNA was isolated from eggs, and the heads of nurse and forager bees. By reverse transcription polymerase chain reaction (RT-PCR), it was shown that the highest expression levels of the ,-glucosidase III gene, in the three examined developmental stadia, were found in forager bees, with much lower expression levels in nurse bees and no detectable expression in eggs. A complete ,-glucosidase III cDNA was obtained by RT-PCR and sequenced. The 1 701 bp cDNA nucleotide sequence and the predicted 567 amino acids it encodes were assayed by BLASTn, BLASTp and BLASTx programs and revealed a 95% and 94% similarity to the A. mellifera,-glucosidase III gene at the DNA and amino acid sequence levels, respectively. For purification of the active encoded enzyme, forager bee heads were homogenized in sodium phosphate buffer solution and the crude extract (0.30 U/mg) sequentially precipitated with 95% saturated ammonium sulfate (0.18 U/mg), and purified by DEAE cellulose ion exchange chromatography (0.17 U/mg), and gel filtration on Superdex 200 (0.52 U/mg). After resolution through sodium dodecyl sulfate-polyacrylamide gel electrophoresis, a single enzymically active band (73 kDa) was identified from renatured substrate gels. Excision of this band, elution of the protein and tryptic peptide digestives identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) revealed six matching masses to the A. mellifera (Q17958) and predicted A. florea,-glucosidase III protein with 12% coverage, supporting the probable purification of the same ,-glucosidase III protein as that encoded by the cloned cDNA. [source] Amyloidosis: a rheumatological perspective on diagnosis, further investigation and treatmentINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 1 2008S. K. L. LAM Abstract In this Grand Round, we present a 58-year-old man with a presumptive diagnosis of rheumatoid arthritis (RA) who was being managed by a plastic surgery unit for a dorsal swelling of his right hand. While awaiting surgery for this lesion, he sustained a pathological fracture of his left neck of femur. This necessitated a total hip joint replacement and pathology revealed amyloidosis. Excision of the hand swelling also revealed amyloidosis as the cause. We discuss the ways in which amyloidosis can mimic musculoskeletal disease as well as the importance and some potential pitfalls of further investigation and management once the diagnosis of amyloidosis has been made. [source] Epidermoid cyst of the penis: A case report and review of the literatureINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2000Michihiro Suwa Abstract Penile cysts are uncommon. A case of a 7-year-old boy with an epidermoid cyst of the penis is reported. He had an asymptomatic, slowly growing soft mass in the frenulum of the penis. Excision of the mass was performed, and the diagnosis was epidermoid cyst of the penis. No recurrence has been noted within the year since excision. To our knowledge, there have been no previous reports of malignancy developing in cystic disease of the penis. In such cases, clinicians should attempt more appropriate management, involving either watchful observation or complete excision of the cyst, by considering the embryogenesis and nature of the disease. [source] Wound conditioning of a deep tissue defect including exposed bone after tumour excision using PROMOGRAN* Matrix, a protease-modulating matrixINTERNATIONAL WOUND JOURNAL, Issue 3 2005Article first published online: 7 SEP 200 Conditionnement d'une plaie créant un défect tissulaire exposant l'os après excision tumorale par Matrice de PROMOGRAN, une matrice modulant les protéases. L'étude d'un cas clinique rapportant le succès thérapeutique sur un patient atteint d'un carcinome baso-cellulaire est relatée. Du fait d'une infiltration cancéreuse profonde, une excision large incluant la résection du tissu osseux, était nécessaire. .Le défect tissulaire profond a été traité par Matrice PROMOGRAN, une matrice modulant les protéases, pour promouvoir le tissu de bourgeonnement et s'assurer que la peau greffée prenne de façon normale. Dans le cas clinique décrit ici, un rapide développement du tissu de bourgeonnement sur la surface osseuse exposée a été observée. Les bénéfices de ce type de pansement ont permis à la greffe de peau d'épaisseur partielle de prendre rapidement et d'aboutir à un résultat satisfaisant sur le plan esthétique et fonctionnel. Wundkonditionierung eines tiefen Gewebedefekts mit freiliegenden Knochen nach Tumorentfernung durch Anwendung einer Promogron Matrix- einer proteasenmodulierenden Matrix Berichtet wird eine Fallstudie nach erfolgreicher Behandlung eines Patienten mit Basalzellcarcinom. Aufgrund der ausgedehnten Tumorinfiltration war eine ausgedehnte Excision des Gewebes unter Einschluss von Knochengewebe erforderlich. Der Tiefe Gewebedefekt wurde mit Promogran, einer proteasemodulierenden Matrix behandelt, um die Granulation zu fördern und eine erfolgreiche Hautransplantation anzuschließen. In dem berichteten Fall konnte eine rasche Ausbildung von Granulationsgewebe auf der Knochenoberfläche beobachtet werden. Dadurch war eine erfolgreiche Spalthauttransplantation mit einem sehr guten ästhetischen und funktionalen Ergebnis möglich. Decorso di una ferita con difetto tessutale profondo, incluso l'esposizione di tessuto osseo dopo escissione di un tumore, dopo utilizzo della matrice Promogran®, una matrice che modula le proteasi. Viene messo in risalto un caso clinico di un paziente trattato con successo per un carcinoma basocellulare. Dal momento che il carcinoma era infiltrato in profondità, è stata necessaria una escissione molto ampia che includesse la rimozione di tessuto osseo. La profonda soluzione di continuo che si è creata è stata trattata con la matrice Promogran®, una matrice che modula le metalloproteasi, per promuovere il tessuto di granulazione ed assicurare che la cute trapiantata avesse buon attecchimento. In questo caso è stato osservato un rapido sviluppo di tessuto di granulazione sulla parte esposta dell'osso. I vantaggi della medicazione hanno consentito l'applicazione di un innesto a spessore parziale che ha portato ad un risultato funzionale ed estetico molto buoni. Acondicionamiento de la herida de un defecto tisular profundo, incluyendo hueso expuesto, tras la escisión de un tumor mediante la matriz PROMOGRAN*, una matriz moduladora de proteasas Se presenta el estudio de un caso informando sobre el tratamiento satisfactorio de un paciente afecto de un carcinoma basocelular. Dado que el carcinoma había causado una infiltración profunda, fue necesario practicar una escisión amplia incluyendo la extirpación de tejido óseo. El defecto tisular profundo fue tratado con la matriz PROMOGRAN*, una matriz moduladora de proteasas, para fomentar la granulación y asegurar que la piel transplantada actuara con éxito. En el estudio de este caso se observó un rápido desarrollo de tejido de granulación sobre la superficie ósea expuesta. Los beneficios del apósito permitieron la realización de un injerto de piel laminar satisfactorio que proporcionó muy buenos resultados estéticos y funcionales. Sårbetingning vid djup vävnadsskada med blottställt ben efter tumör excision, med hjälp av PROMOGRAN* Matrix, ett proteas-modulerande matrix En fallstudie som rapporterar lyckad behandling av en patient med basalcellcancer framställs. En omfattande excision, som inkluderar avlägsnandet av benvävnad, var nödvändig emedan cancern hade infiltrerat djupt. Den djupa vävnadsskadan behandlades med PROMOGRAN* Matrix, ett protease-modulerande matrix, för att befrämja granulation och för att säkerställa lyckad inläkning av hudtransplantatet. I denna fallstudie iakttogs en snabb uppkomst av granulationsvävnad på den blottställda benytan. Den fördelaktiga effekten av sårförbandet möjliggjorde en lyckad ,split-thickness' hudtransplantation med mycket gott estetiskt och funktionellt resultat. [source] Combined Cardiac Surgery and Excision of a Retrosternal Thyroid Mass: A Case ReportJOURNAL OF CARDIAC SURGERY, Issue 3 2006Gilbert H. L. Tang M.D. We describe a combined thyroidectomy, aortic valve replacement, and coronary artery bypass graft surgery on a patient with an asymptomatic retrosternal thyroid mass. [source] Rippled-pattern trichoblastoma with apocrine differentiation arising in a nevus sebaceus: report of a case and review of the literatureJOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2009Brian L. Swick A 36-year-old man developed a papular growth in a portion of a nevus sebaceus on the post-auricular scalp. Excision showed typical histologic changes of nevus sebaceus including epidermal papillomatosis with reduced numbers of hair follicles as well as numerous sebaceous glands high in the dermis that focally emptied directly to the overlying epidermis. Histologic sections of the papular growth at the superior pole of the nevus sebaceus showed a proliferation of cytologically bland basaloid epithelial tumor lobules both in the superficial dermis, with multiple connections to the epidermis, and within the deeper dermis in a nodular growth pattern demonstrating papillary mesenchymal bodies. Ductal structures with apocrine-type decapitation secretion were present. There was prominent palisading of nuclei in rows parallel to one another, alternating with bands of homogenous eosinophilic stromal material forming a ripple pattern resembling the Verocay bodies of schwannoma. The histologic features resembled those of rippled-pattern trichoblastoma with apocrine differentiation arising in a nevus sebaceus, an association not previously described. We discuss this case as well as review the literature on rippled-pattern trichoblastoma. [source] Subclinical chronic lymphocytic leukaemia associated with a 13q deletion presenting initially in the skin: apropos of a caseJOURNAL OF CUTANEOUS PATHOLOGY, Issue 3 2006Abha Khandelwal Introduction:, B-cell chronic lymphocytic leukaemia (B-CLL) represents a low-grade B-cell lymphoproliferative disease that is the most common leukaemia in adults. The neoplastic cell is an autoreactive CD5 CD23 B lymphocyte. B-CLL may involve the skin, typically in the context of known disease. We present a case of subclinical B-CLL presenting initially in the skin. Case Report:, A 73-year-old male developed a lesion on his right cheek in April 2003 compatible with basal cell carcinoma. The re-excision specimen contained a well-differentiated atypical lymphocytic infiltrate consistent with B-CLL along with residual carcinoma. Subsequent laboratory studies revealed peripheral blood lymphocytosis with smudge cells. A diagnosis was made of Rai stage 0 CLL. Chromosomal studies on peripheral blood showed a deletion at 13q14.3. Excision of a second primary skin carcinoma revealed a squamous cell carcinoma in association with B-CLL that was identical to his previously diagnosed skin involvement. Conclusion:, This case identifies a cutaneous presentation of subclinical B-CLL. There are two prior reports describing B-CLL presenting initially in the skin. In one case, the infiltrates were incidental on a re-excision specimen. The second report suggests 16% of B-CLL patients have cutaneous manifestations as the first sign of disease. [source] The role of surgery in breast cancer patients with isolated bone metastases at the time of diagnosisJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2009Sevim Turanli MD Abstract Background Surgery for the primary tumor in breast cancer patients with synchronous isolated bone metastasis is applied for palliation. The aim was to determine whether surgical removal of the primary tumor provides a better survival and disease progression. Methods Forty-four patients were diagnosed between the dates June 2004 and January 2007 and these patients are classified according to the removal of the primary tumor or not. Patients and tumor characteristics, removal of the primary tumor, and response to systemic therapy are examined as the factors that were affecting overall survival and time to progression of the disease. Results The median follow-up time was 37.5 months. Mean time to progression and overall survival was longer for the patients who received surgery than the patients who did not (20.4 vs. 18.4 months and 57.6 vs. 44.5 months, respectively), but these were not significant (P,=,0.58, P,=,0.39). In multivariate analysis, response to systemic treatment [(P,=,0.03), hazard ratio,=,0.44, 95% confidence interval,=,0.20,0.93] was independent factor associated with overall survival. Conclusion The response to systemic therapy is the major factor on survival in the breast cancer patients with isolated bone metastasis. Excision of the primary tumor has no effect on time to progression and overall survival. J. Surg. Oncol. 2009;100:95,99. © 2009 Wiley-Liss, Inc. [source] Opposed bilateral transposition flap: a simple and effective way to close large defects, especially of the limbsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2008R Verdolini Abstract Background, Excision of large tumours, particularly of the limbs, can be challenging because of problems related to wound repair. This is especially true of the lower legs, where skin is often tight and difficult to mobilize. Closure by flap, which would represent the first choice for defects usually between 12,15 mm to 38,40 mm diameter, is at risk of developing complications, such as end-flap necrosis or dehiscence due to skin tension. For larger defects, usually more than 40 to 45 mm diameter, grafting still remains the only realistic option in the majority of cases, with all the various problems associated with this procedure, such as lengthy healing times and the risk of developing leg ulcers, above all in elderly patients with impaired blood circulation. Second intention healing implies extraordinarily long healing times with often unacceptable delays in normal ambulation and activity. Objective, To find an alternative to the usual repair techniques and to try to reduce the risk of complications. Conclusions, We developed a relatively simple but effective technique for the closure of large wounds resulting from the excision of tumours. Our technique consists of two longitudinal, parallel, transposition flaps obtained from two opposite sides of the wound, with major axes orientated in the cephalic-caudal direction. The two flaps are then rotated around two fulcra placed at two extremes of the wound by approximately 90°. This relatively simple technique has never caused any of the ordinarily associated problems in terms of necrosis or ulcer development. In addition, dehiscence of sutures never occurred, given the fact that suture tension is minimal. Quick healing has resulted in the majority of cases, avoiding all the problems associated with grafting or other traditional flap techniques. [source] Excision of selectable marker genes from transgenic crops as a concern for environmental biosafetyJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 14 2007Satheesh Natarajan Abstract The main task in the development of transgenic plants is the capability to distinguish between plant cells with an integrated transgene and the bulk of non-transformed cells. Selectable marker genes are required to achieve this goal within the transgene, and to select for their expression. These selectable markers are mostly based on genes conferring antibiotic or herbicide resistance. The presence of the marker gene will lead to unpredictable environmental hazards, so on the basis of economic incentives and safety concerns, several methods, such as site-specific recombination, homologous recombination and co-transformation, have been developed to eliminate these genes from the genome after successful transformation has been achieved. Gene transfer without the incorporation of an antibiotic-resistance marker or herbicide-resistance marker in the host genome should convince the public with regard to the field release of transgenic organisms. Moreover, it would obviate the need for different selectable markers in subsequent rounds of gene transfer into the same host. Copyright © 2007 Society of Chemical Industry [source] Identification and characterization of the immunity repressor (ImmR) that controls the mobile genetic element ICEBs1 of Bacillus subtilisMOLECULAR MICROBIOLOGY, Issue 6 2007Jennifer M. Auchtung Summary ICEBs1 is a mobile genetic element found in the chromosome of Bacillus subtilis. Excision and transfer of ICEBs1 is regulated by the global DNA damage response and intercellular peptide signalling. We identified and characterized a repressor, ImmR (formerly YdcN), encoded by ICEBs1. ImmR represses transcription of genes required for excision and transfer, and both activates and represses its own transcription. ImmR regulates transcription within ICEBs1 by binding to several sites in the region of DNA that contains promoters for both immR and xis (encoding excisionase). In addition, we found that ImmR confers immunity from acquisition of additional copies of ICEBs1. ImmR-mediated regulation serves to keep a single copy of ICEBs1 stably maintained in the absence of induction, allows a rapid response to inducing signals, and helps limit acquisition of additional copies of ICEBs1. [source] Excision from tRNA genes of a large chromosomal region, carrying avrPphB, associated with race change in the bean pathogen, Pseudomonas syringae pv. phaseolicolaMOLECULAR MICROBIOLOGY, Issue 2 2000Robert W. Jackson Pseudomonas syringae pv. phaseolicola (Pph) race 4 strain 1302A carries avirulence gene avrPphB. Strain RJ3, a sectoral variant from a 1302A culture, exhibited an extended host range in cultivars of bean and soybean resulting from the absence of avrPphB from the RJ3 chromosome. Complementation of RJ3 with avrPphB restored the race 4 phenotype. Both strains showed similar in planta growth in susceptible bean cultivars. Analysis of RJ3 indicated loss of >,40 kb of DNA surrounding avrPphB. Collinearity of the two genomes was determined for the left and right junctions of the deleted avrPphB region; the left junction is ,,19 kb and the right junction >,20 kb from avrPphB in 1302A. Sequencing revealed that the region containing avrPphB was inserted into a tRNALYS gene, which was re-formed at the right junction in strain 1302A. A putative lysine tRNA pseudogene (,tRNALYS) was found at the left junction of the insertion. All tRNA genes were in identical orientation in the chromosome. Genes near the left junction exhibited predicted protein homologies with gene products associated with a virulence locus of the periodontal pathogen Actinobacillus actinomycetemcomitans. Specific oligonucleotide primers that differentiate 1302A from RJ3 were designed and used to demonstrate that avrPphB was located in different regions of the chromosome in other strains of Pph. Deletion of a large region of the chromosome containing an avirulence gene represents a new route to race change in Pph. [source] Molecular physiology of adventitious root formation in Petunia hybrida cuttings: involvement of wound response and primary metabolismNEW PHYTOLOGIST, Issue 3 2009Amir H. Ahkami Summary ,,Adventitious root formation (ARF) in the model plant Petunia hybrida cv. Mitchell has been analysed in terms of anatomy, gene expression, enzymatic activities and levels of metabolites. This study focuses on the involvement of wound response and primary metabolism. ,,Microscopic techniques were complemented with targeted transcript, enzyme and metabolite profiling using real time polymerase chain reaction (PCR), Northern blot, enzymatic assays, chromatography and mass spectrometry. ,,Three days after severance from the stock plants, first meristematic cells appeared which further developed into root primordia and finally adventitious roots. Excision of cuttings led to a fast and transient increase in the wound-hormone jasmonic acid, followed by the expression of jasmonate-regulated genes such as cell wall invertase. Analysis of soluble and insoluble carbohydrates showed a continuous accumulation during ARF. A broad metabolite profiling revealed a strong increase in organic acids and resynthesis of essential amino acids. ,,Substantial changes in enzyme activities and metabolite levels indicate that specific enzymes and metabolites might play a crucial role during ARF. Three metabolic phases could be defined: (i) sink establishment phase characterized by apoplastic unloading of sucrose and being probably mediated by jasmonates; (ii) recovery phase; and (iii) maintenance phase, in which a symplastic unloading occurs. [source] Surgical Excision of Pedunculated Supernumerary Digits Prevents Traumatic Amputation NeuromasPEDIATRIC DERMATOLOGY, Issue 2 2003Geoffrey E. Leber The first group consisted of three patients who had among them five traumatic amputation neuromas. In each case these lesions resulted from primary suture ligation of accessory digits in infancy. Secondary surgical excision of the vestigial digit with high ligation and retraction of the accompanying nerve tissue was required in all cases. The second group consisted of six patients who had 12 pedunculated supernumerary digits. Primary surgical excision of these digits was performed with high transection and retraction of the accompanying accessory digital nerve. All patients in this group had excellent cosmetic results with no postoperative neuroma formation. Adult family members who had undergone suture ligation of similar supernumerary digits in infancy accompanied seven of the nine patients in this series. On careful examination, each of these family members had signs and symptoms attributable to traumatic amputation neuromas. We feel identification and high transection of the accessory digital nerve is essential in the treatment of pedunculated supernumerary digits. This treatment prevents traumatic amputation neuromas and yields a better cosmetic result than the traditional method of suture ligation in infancy. [source] Raney Clips: Excision of Vascular Lesions on the Scalp Made (Ridiculously) SimplePEDIATRIC DERMATOLOGY, Issue 3 2000Judith V. Williams M.D. No abstract is available for this article. [source] | |||||||||||||||||||||||||||||||||||||||||||