Prevention of seroma formation after axillary dissection in breast cancer: A systematic review

International audienceTo analyze longitudinal changes in each subscale of a quality of life (QOL) measure and to explore their relationships to effective QOL predictors in breast cancer surgery patients

SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals

Gaafheid van bodem en reliëf gemeente Lingewaal en gemeente Geldermalsen; kennisinstrument bij de relatie cultuurhistorie en ruimtelijke ontwikkelingen

Dit project betreft een kennisproject dat als doelstelling heeft om nieuwe, breed toepasbare kennis te ontwikkelen over cultuurhistorische waarden in samenhang met de gaafheid van bodem en reliëf. Dit heeft voor de gemeenten Lingewaal en Geldermalsen een reëel (kaart)beeld opgeleverd van de gaafheid van bodem en reliëf en de aanwezigheid hierin en samenhang hiermee met archeologische, cultuurhistorische en aardkundige waarden. Deze informatie is gebundeld in een webportaa

Prevention of seroma formation after axillary dissection in breast cancer: a systematic review

BACKGROUND The most common complication after breast cancer surgery is seroma formation. It is a source of significant morbidity and discomfort. Many articles have been published describing risk factors and preventive measures. The aim of this paper is to provide a systematic review of studies and reports on risk factors and preventive measures. Surgery lies at the core of seroma formation; therefore focus will be placed on surgical ways of reducing seroma. METHODS A computer assisted medline search was carried out, followed by manual retrieval of relevant articles found in the reference listings of original articles. RESULTS 136 relevant articles were reviewed. Though the level of evidence remain varied several factors, type of dissection, tools with which dissection is carried out, reduction of dead space, suction drainage, use of fibrin glue and octreotide usage, have been found to correlate with seroma formation and have been shown to significantly reduce seroma rates. CONCLUSION Seroma formation after breast cancer surgery cannot be avoided at present. There are however several methods to minimize seroma and associated morbidity. Future research should be directed towards the best ways of reducing seroma by combining proven methods.Surgical oncolog

Gaafheid van bodem en reliëf gemeente Lingewaal en gemeente Geldermalsen; kennisinstrument bij de relatie cultuurhistorie en ruimtelijke ontwikkelingen

Dit project betreft een kennisproject dat als doelstelling heeft om nieuwe, breed toepasbare kennis te ontwikkelen over cultuurhistorische waarden in samenhang met de gaafheid van bodem en reliëf. Dit heeft voor de gemeenten Lingewaal en Geldermalsen een reëel (kaart)beeld opgeleverd van de gaafheid van bodem en reliëf en de aanwezigheid hierin en samenhang hiermee met archeologische, cultuurhistorische en aardkundige waarden. Deze informatie is gebundeld in een webportaa

Prevention of seroma formation after axillary dissection in breast cancer: A systematic review

Surgical oncolog