No abstract

Therapeutic, IV.

The oncoplastic approach to breast conservation therapy has become a useful and popular option for women with breast cancer who wish to preserve their breast. The initial driving forces were aimed at minimizing the potential for a breast conservation therapy deformity; however, various other benefits have been identified that include broadening the indications for breast conservation therapy in some patients and improved margin control. The various techniques can be categorized into glandular rearrangement techniques such as breast reductions usually in patients with larger breasts or flap reconstruction such as the latissimus dorsi muscle usually in patients with smaller breasts. As the acceptance continues to increase, we are starting to see more outcomes evidence in terms of patient satisfaction, quality of life, complications, and recurrence, to further support the safety and efficacy of the oncoplastic approach.

The oncoplastic reduction technique is effective and results in improved patient-reported outcomes. Resections over 1000 g are associated with a higher incidence of positive margins and may increase the risk for completion mastectomy. Outcomes have improved with experience and refinement in technique.

Background Partial breast reconstruction with reduction mammaplasty is an accepted option for women with breast cancer who wish to receive breast conserving therapy. With additional surgery and potential postoperative complications, the impact this approach has on the timely initiation of adjuvant radiation therapy has been raised as a concern. The purpose of this study was to determine if any postoperative complications after oncoplastic reduction (OCR) are associated with a delay in time to radiation. Methods All patients undergoing OCR with postoperative adjuvant radiation at a single institution between 1997 and 2015 were included in the analysis. Women who received adjuvant chemotherapy or experienced delays in radiation therapy due to nonsurgical reasons were excluded from our analysis. Comparisons were made between the time to radiation for patients with surgical complications and those without. Results One hundred eighteen patients were included. Twenty-six (22.0%) experienced a surgical complication. Complications included cellulitis, delayed healing, seroma, wound breakdown, and wound dehiscence. Postoperative complications resulted in a significantly different median time interval for initiation of radiation (74 days vs 54 days, P < 0.001) compared to those without a complication. Among the entire cohort, 5% of patients required a second operative procedure due to complications. (n = 6/118 patients) including hematoma, infection, seroma, open wounds, wound dehiscence, and nipple necrosis. There was no difference in median time to radiation therapy in those with complications who returned to the operating room (73 days) compared to those who did not (74 days, P = 0.692). Conclusion Postoperative complications following OCR procedures were associated with an increased time to initiation of adjuvant radiation therapy regardless of whether or not the complication required reoperation. This needs to be taken into consideration when planning these combined procedures with every attempt made to minimize complications through patient selection and surgical technique.

4.

Capture of wild, juvenile herring Clupea pallasii from Puget Sound (Washington, USA) and confinement in laboratory tanks resulted in outbreaks of viral hemorrhagic septicemia (VHS), viral erythrocytic necrosis (VEN) and ichthyophoniasis; however, the timing and progression of the 3 diseases differed. The VHS epidemic occurred first, characterized by an initially low infection prevalence that increased quickly with confinement time, peaking at 93 to 98% after confinement for 6 d, then decreasing to negligible levels after 20 d. The VHS outbreak was followed by a VEN epidemic that, within 12 d of confinement, progressed from undetectable levels to 100% infection prevalence with > 90% of erythrocytes demonstrating inclusions. The VEN epidemic persisted for 54 d, after which the study was terminated, and was characterized by severe blood dyscrasias including reduction of mean hematocrit from 42 to 6% and replacement of mature erythrocytes with circulating erythroblasts and ghost cells. All fish with ichthyophoniasis at capture died within the first 3 wk of confinement, probably as a result of the multiple stressors associated with capture, transport, confinement, and progression of concomitant viral diseases. The results illustrate the differences in disease ecology and possible synergistic effects of pathogens affecting marine fish and highlight the difficulty in ascribing a single causation to outbreaks of disease among populations of wild fishes.KEY WORDS: Disease · Fish · Viral hemorrhagic septicemia · Viral erythrocytic necrosis · Ichthyophonus · Pacific herring · Wild fish Resale or republication not permitted without written consent of the publisherDis Aquat Org 70: [201][202][203][204][205][206][207][208] 2006 Sardinops sagax biomass from 165 000 to 37 000 tonnes in 1995 and from 147 000 to 36 000 tonnes in 1998 (Jones et al. 1997, Whittington et al. 1997, Gaughan et al. 2000, Ward et al. 2001. Although mortality was associated with herpesvirus-like particles in the gills of affected sardines (Hyatt et al. 1997, Jones et al. 1997, Gaughan et al. 2000, transmission studies and attempts to fulfill Koch's postulates were unsuccessful (Bernoth 2002).In Puget Sound, Washington (USA), several pathogenic agents, including viral hemorrhagic septicemia virus (Hershberger et al. 1999, Kocan et al. 2001, erythrocytic necrosis virus (MacMillan & Mulcahy 1979) and Ichthyophonus hoferi (Kocan et al. 1999, Hershberger et al. 2002 are enzootic in populations of Pacific herring Clupea pallasii. Viral hemorrhagic septicemia virus (VHSV) is grouped with several other commercially and ecologically important fish viruses in the Novirhabdovirus genus of the family Rhabdoviridae (Walker et al. 2000). North American isolates belong to VHSV Genogroup IV and have been recovered almost exclusively from marine or anadromous fishes, similar to reports for the European Genogroups Ib, II and III (Snow et al. 2004). Juvenile and newly recruited Pacific herring are highly susceptible to VHSV (Kocan et al. 1997), and applica...

Therapeutic, III.