Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer

<p>Abstract</p> <p>Background</p> <p>Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.</p> <p>Methods</p> <p>In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (<it>n </it>= 35) or placebo (<it>n </it>= 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.</p> <p>Results</p> <p>Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% <it>vs</it>. 60%; <it>p </it>= 0.02) and at 6 h (17.2% <it>vs</it>. 45.8%; <it>p </it>= 0.03). More patients in the placebo group required additional antiemetic medication (21 <it>vs</it>. 8; <it>p </it>= 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 <it>vs</it>. 5.83 ± 2.00; <it>p </it>= 0.004), at 6 h (3.03 ± 1.20 <it>vs</it>. 4.17 ± 1.24; <it>p </it>< 0.0005) and at 12 h (2.09 ± 0.85 <it>vs</it>. 2.54 ± 0.98; <it>p </it>= 0.04). Analgesics were required in more patients of the control group (21 <it>vs</it>. 10; <it>p </it>= 0.008). There were no adverse events, morbidity or mortality.</p> <p>Conclusions</p> <p>Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.</p> <p>Trial registration number</p> <p>NCT01116713</p

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3) : analysis of individual data from 258 cancer registries in 61 countries

Background Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings 164563 young people were included in this analysis: 121328 (73·7%) children, 22963 (14·0%) adolescents, and 20272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group.peer-reviewe

Breast tuberculosis: a report of five cases

Abstract Background Breast tuberculosis is a rare form of extrapulmonary tuberculosis with clinical and radiological misleading presentations. We report herein a retrospective study of clinicopathological features of five cases of breast tuberculosis collected at Hassan II University Hospital of Fès, Morocco, a country where tuberculosis is endemic. Case presentation The mean age was 40.6 years (range of 21–59 years). Two patients presented with abscessed lesions, and three cases presented with breast lumps with a suspicion of malignancy on imaging techniques. The diagnosis has been made on histological specimens (3 biopsy specimens, 1 excisional biopsy, and 1 lumpectomy). All patients have been successfully treated after the completion of the standard antibiotherapy. Conclusions Our current study shows that the breast is rarely affected by tuberculosis even in endemic area. The clinical presentation is often misleading, and the histopathological analysis constitutes a valuable diagnostic tool. The prognosis of breast tuberculosis is good after treatment by a standard antibiotherapy

Tubular Adenoma of the Breast: A Clinicopathologic Study of a Series of 9 Cases

Tubular adenoma of the breast is one of the most rare benign neoplasms, accounting for only 0.13% to 1.7% of all breast benign tumors. Little is known about this rare neoplasm as the current literature offers only some case reports or a few number of small series. The aim of our study is to provide some clinicopathologic features of the breast tubular adenoma. We retrospectively analyzed at our department of pathology all cases of breast tubular adenomas confirmed by immunohistochemistry over a period of 9 years (2009-2017). Nine cases of breast tubular adenoma have been recorded, with an average age of 31.44 years. Five tumors were located at the right side (55.55%), and most cases had suspicious aspects on imaging techniques (6 cases out of 9). The diagnosis has been made on 5 resected specimens (lumpectomy) and on 4 core needle biopsies. The tumor size ranged from 0.9 to 7 cm (mean size of 3.08 cm) and had well-circumscribed margins with elastic consistency. The histopathologic analysis showed a typical pattern of proliferating round and uniform tubules lined by regular epithelial cells surrounded by myoepithelial cells, packed in a small amount of stroma, highlighted by CD34 immunostaining. Tubular adenoma is a rare breast benign neoplasm of young premenopausal women. The radiologic aspects are often worrisome and only the histopathologic analysis can achieve the correct definitive diagnosis by excluding all potential differential diagnoses

Case Report - Cardiomyopathie hypertrophique néonatale de diagnostic étiologique difficile

La cardiomyopathie hypertrophique n&#233;onatale est une entit&#233; rare, h&#233;t&#233;rog&#232;ne regroupant plusieurs formes cliniques et donc de diagnostic &#233;tiologique difficile. Nous rapportons l&#8217;observation d&#8217;un nouveau n&#233; issu d&#8217;une grossesse g&#233;mellaire, ayant pr&#233;sent&#233; &#224; la naissance un tableau d&#8217;insuffisance cardiaque, l&#8217;&#233;chocardiographie avait conclut &#224; une cardiomyopathie hypertrophique obstructive. Le bilan &#233;tiologique &#233;tait n&#233;gatif notamment une m&#232;re non diab&#233;tique. L&#8217;&#233;volution &#233;tait favorable avec r&#233;gression de l&#8217;hypertrophie 2 semaines apr&#232;s la naissance. L&#8217;&#233;tiologie finalement sugg&#233;r&#233;e &#233;tait une cardiomyopathie secondaire &#224; l&#8217;injection ant&#233;natale de cortico&#239;des dans le but d&#8217;acc&#233;l&#233;rer la maturation pulmonaire. L&#8217;&#233;tablissement par les soci&#233;t&#233;s savantes d&#8217;un consensus de bilan &#233;tiologique minimal standard selon une chronologie bien d&#233;termin&#233;e serait d&#8217;un grand apport dans la prise en charge de cette anomalie

TrollMagnifier: Detecting State-Sponsored Troll Accounts on Reddit

Growing evidence points to recurring influence campaigns on social media, often sponsored by state actors aiming to manipulate public opinion on sensitive political topics. Typically, campaigns are performed through instrumented accounts, known as troll accounts; despite their prominence, however, little work has been done to detect these accounts in the wild. In this paper, we present TROLLMAGNIFIER, a detection system for troll accounts. Our key observation, based on analysis of known Russian-sponsored troll accounts identified by Reddit, is that they show loose coordination, often interacting with each other to further specific narratives. Therefore, troll accounts controlled by the same actor often show similarities that can be leveraged for detection. TROLLMAGNIFIER learns the typical behavior of known troll accounts and identifies more that behave similarly. We train TROLLMAGNIFIER on a set of 335 known troll accounts and run it on a large dataset of Reddit accounts. Our system identifies 1,248 potential troll accounts; we then provide a multi-faceted analysis to corroborate the correctness of our classification. In particular, 66% of the detected accounts show signs of being instrumented by malicious actors (e.g., they were created on the same exact day as a known troll, they have since been suspended by Reddit, etc.). They also discuss similar topics as the known troll accounts and exhibit temporal synchronization in their activity. Overall, we show that using TROLLMAGNIFIER, one can grow the initial knowledge of potential trolls provided by Reddit by over 300%