Biomedical subjects

L Fortunato

Publications and source records attributed to L Fortunato.

54 records · Page 3Linked to original sources

PubMedDate not supplied

Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy.

Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap after skin-sparing mastectomy is becoming an increasingly performed procedure in patients with ductal carcinoma in situ, early invasive breast cancer, and prophylactic mastectomy. Through a periareolar approach, it is possible to remove the breast parenchyma along with the nipple areola complex, preserving almost all the original skin envelope and the inframmamary fold. The TRAM flap is used to recreate the volume and shape of the original breast. This technique has higher quality and easier reconstruction. The major disadvantages, extensive scar and donor site skin color mismatch, are reduced to a minimum level because the former is limited at the natural border of the nipple areola and the latter can be effectively concealed with proper nipple reconstruction. Thirty-one patients with a mean age of 39 years (range, 26-50 years) who had undergone unilateral or bilateral mastectomy for early breast cancer and immediate breast reconstruction with the pedicled TRAM flap were retrospectively reviewed. Requirements for the skin-sparing mastectomy technique include suitability of donor site tissue for autologous tissue, early breast cancer or ductal carcinoma in situ, and adequate size and shape matching of the contralateral breast. There was no observed local recur- rence during the follow-up period (mean, 20 months; range, 11-30 months). Complications at the recipient site include mastectomy skin flap partial necrosis in 2 patients and cellulitis of the transferred flap in 1 patient. No total or partial flap necrosis was observed. One patient developed abdominal bulging 1 month after the operation, during the administration of chemotherapy. All reconstruction was considered very satisfactory from an aesthetic perspective by the surgeon and the patient. The nicer aesthetic result with oncological safety is achieved with immediate breast reconstruction with the TRAM flap after skin-sparing mastectomy. The risk of local recurrence is not higher compared with more radical surgical techniques.

Adult↗

PubMedDate not supplied

[Extemporaneous examination of the sentinel lymph node in breast cancer: is the glass half full or half empty?].

Intra-operative examination of sentinel LN is controversial. Concordance with definitive exam of SLN in this series was 81%, though only 54% of positive cases were diagnosed. Micrometastases and ITC were usually lost intraoperatively, accounting for 14% of cases. Frozen section and touch prep of the SLN were approximately equivalent. The latter has the advantage of preserving tissue for step-analysis of SLN. The ultimate method of intraoperative analysis of SLN which can combine cost-effectiveness and accuracy needs to be determined.

Aged↗

PubMedDate not supplied

[Locally advanced and recurrent pelvic colorectal carcinoma: results of aggressive surgical treatment].

Pelvic exenteration has been described as a formidable procedure in cases of advanced or recurrent pelvic cancers for a variety of primary tumors, including colorectal, gynaecologic and urologic. We report our 14-year experience in a community hospital with 37 cases who underwent pelvic exenteration for recurrent (n = 15) or locally advanced (n = 22) colorectal cancers. At a median follow-up of 36 months, the median survival was 24 and 36 months, respectively, and the 5-year actuarial survival was 18% and 44%.

Adult↗

PubMedDate not supplied

[Hormone-dependence and C-ERBB2: relationship between estrogen receptor expression, estrogen-regulated proteins, and C-ERBB2 in breast carcinoma].

We reviewed 1491 consecutive cases of operated breast cancer between 1999-2004, and found that hormone-dependence, particularly if evaluated with functional markers of the estrogen receptor (estrogen regulated proteins, ERP), is inversely proportional to antigen neu expression. Our data confirms that ERP can give additional information on the probability of response to hormonal therapy.

Breast Neoplasms↗

PubMedDate not supplied

[Predictive variables of lymphatic metastasis in breast carcinoma with a diameter below 2 cm].

The axillary lymph node status of patients with newly diagnosed breast cancer remains the most important prognostic information available at the moment. However, only a minority of patients presents with such node metastases at diagnoses. We reviewed our database and studied 500 consecutive patients with early breast cancer, and found that age inferior to 50 years, high grade, diameter superior to 1 cm, elevated Ki-67, and expression of oncogene p-53 are all factors associated with lymph node metastases.

Breast Neoplasms↗

PubMedDate not supplied

[Towards the standardization of sentinel lymph node analysis in women with breast cancer].

Sentinel lymph node biopsy allows enhanced pathology through serial sections and immunohistochemical analysis of the retrieved node, with detection of micrometastases and isolated tumor cells not otherwise recognized. We present our experience with a simple, effective, pathology protocol requiring six couples of sections at three different sentinel lymph node levels. Additional micrometastases or ITC were diagnosed in 51/416 patients (14.6%).

Breast Neoplasms↗

PubMedDate not supplied

[Does incidence of sentinel lymph node metastasis increase after diagnostic manipulation in women with breast cancer?].

503 patients were retrospectively evaluated to assess whether a previous needle or core biopsy, or surgical surgical excision of the primary tumor are associated with passive dislodgment of tumor cells in the sentinel lymph node, as reported in recent publications. We could not identify any increased incidence of sentinel lymph node micrometastases or isolated tumor cells after diagnostic manipulation of the primary tumor.

Breast Neoplasms↗

PubMedDate not supplied

[Strategic approach to immediate breast reconstruction with submuscular-fascial tissue expanders].

Breast reconstruction can be accomplished with implants, autologous tissue or both. Thanks to the widespread of microsurgical techniques autologous tissue reconstruction has become a frequent option in many departments although it is mostly considered a second choice. The aim of this study was to review our experience covering the past five years in immediate breast reconstruction with tissue expanders. From January 2000 to January 2005 279 patients underwent immediate breast reconstruction with submuscular tissue expanders. Tissue expander was chosen according to dimension, shape and volume of the healthy breast. Operating time, early and late complications, interference with neo-adjuvant therapies as well as timing and surgical techniques of second-step reconstruction were also considered. No major complications occurred. Tissue expander, beyond proving itself a valid and safe option in immediate breast reconstruction, also decreased the psychological distress following a mastectomy.

Breast Neoplasms↗

PubMedDate not supplied

[Role of cutaneous thoraco-abdominal flap in the surgical treatment of advanced stage breast tumors].

Chest wall reconstruction following extensive resection due to advanced breast cancer or radionecrosis still represents a challenge for both oncologic and reconstructive surgeons. A multitude of techniques including pedicle muscle transposition, free muscle flaps and omental flaps have always been considered, despite the morbidity of donor site. The authors describe a new cutaneous thoraco-abdominal flap to cover full thickness defects up to 600 cm2. 16 patients underwent chest wall reconstruction with the aforementioned technique. No major complications occurred. This technique proved to be a very good options to cover large chest wall defects in patients with advanced or recurred breast cancer or radionecrosis.

Breast Neoplasms↗

PubMedDate not supplied