The Feasibility of Endoscopy-Assisted Breast Conservation Surgery for Patients with Early Breast Cancer

PURPOSE: Breast conservation surgery (BCS) has become a standard treatment method for patients with early breast cancer. Endoscopy-assisted BCS (EABCS) can be performed through an inconspicuous periareolar and a small axillary incision for sentinel node biopsy, which may give better cosmetic outcomes than conventional BCS skin incisions. This study was designed to evaluate the feasibility of EABCS for patients with early breast cancer. METHODS: Forty-three patients were candidates for EABCS, and EABCS was performed in 40 patients with breast cancer between January 2008 and July 2010. Their clinicopathological features were retrospectively analyzed. Operative time, margin status, complications, and relapse-free survival were compared with those of patients treated by conventional BCS and who were treated at the same institute during the same period. RESULTS: The most common lesion site of the EABCS and conventional BCS groups was the upper area of the breast. Tumor size in all patients was less than 4 cm (range, 0.4-3.7 cm), and nodal involvement was found in eight (20%) patients in the BCS group. The mean operative time was 110 minutes for the EABCS group and 107 minutes for the conventional BCS group, and those were not significantly different. No significant difference in frozen or final margin status was observed between the EABCS and conventional BCS groups. Relapse-free survival was statistically equivalent between the groups with a median follow-up of 12 months. Postoperative complications occurred in five cases in four patients with EABCS, which was not significantly different from conventional BCS. CONCLUSION: Performing EABCS in patients with early breast cancer seems to be feasible and safe. Further study with a longer-term follow-up may be needed to confirm the clinical value of EABCS.ope

A core outcome domain set for clinical research on capillary malformations (the COSCAM project):an e-Delphi process and consensus meeting

BACKGROUND: There is limited evidence on the best available treatment options for capillary malformations (CMs), mainly due to the absence of uniform outcome measures in trials on therapies. A core outcome set (COS) enables standard reporting of trial outcomes, which facilitates comparison of treatment results. OBJECTIVES: To develop a core outcome domain set (CDS), as part of a core outcome set (COS), for clinical research on CMs. METHODS: Sixty‐seven potentially relevant outcome subdomains were recognized based on the literature, focus group sessions, and input from the COSCAM working group. These outcome subdomains were presented in an online Delphi study to CM experts (medical specialists and authors of relevant literature) and (parents of) patients with CM (international patient associations). During three e‐Delphi study rounds, the participants repeatedly scored the importance of these outcome subdomains on a seven‐point Likert scale. Participants could also propose other relevant outcome subdomains. Consensus was defined as ≥ 80% agreement as to the importance of an outcome subdomain among both stakeholder groups. The CDS was finalized during an online consensus meeting. RESULTS: In total 269 participants from 45 countries participated in the first e‐Delphi study round. Of these, 106 were CM experts from 32 countries, made up predominantly of dermatologists (59%) and plastic surgeons (18%). Moreover, 163 (parents of) patients with CM from 28 countries participated, of whom 58% had Sturge–Weber syndrome. During the two subsequent e‐Delphi study rounds, 189 and 148 participants participated, respectively. After the entire consensus process, consensus was reached on 11 outcome subdomains: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health‐related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. CONCLUSIONS: We recommend the CDS to be used as a minimum reporting standard in all future trials of CM therapy. Our next step will be to select suitable outcome measurement instruments to score the core outcome subdomains. What is already known about this topic? Besides physical and functional sequelae, capillary malformations (CMs) often cause emotional and social burden. The lack of uniform outcome measures obstructs proper evaluation and comparison of treatment strategies. As a result, there is limited evidence on the best available treatment options. The development of a core outcome set (COS) may improve standardized reporting of trial outcomes. What does this study add? A core outcome domain set (CDS), as part of a COS, was developed for clinical research on CMs. International consensus was reached on the recommended core outcome subdomains to be measured in CM trials: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health‐related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. This CDS enables the next step in the development of a COS, namely to reach consensus on the core outcome measurement instruments to score the core outcome subdomains. What are the clinical implications of this work? The obtained CDS will facilitate standardized reporting of treatment outcomes, thereby enabling proper comparison of treatment results. This comparison is likely to provide more reliable information for patients about the best available treatment options

An Overview of Three Promising Mechanical, Optical, and Biochemical Engineering Approaches to Improve Selective Photothermolysis of Refractory Port Wine Stains

During the last three decades, several laser systems, ancillary technologies, and treatment modalities have been developed for the treatment of port wine stains (PWSs). However, approximately half of the PWS patient population responds suboptimally to laser treatment. Consequently, novel treatment modalities and therapeutic techniques/strategies are required to improve PWS treatment efficacy. This overview therefore focuses on three distinct experimental approaches for the optimization of PWS laser treatment. The approaches are addressed from the perspective of mechanical engineering (the use of local hypobaric pressure to induce vasodilation in the laser-irradiated dermal microcirculation), optical engineering (laser-speckle imaging of post-treatment flow in laser-treated PWS skin), and biochemical engineering (light- and heat-activatable liposomal drug delivery systems to enhance the extent of post-irradiation vascular occlusion)

Characterisation and treatment of patients with port wine stains with special reference to the emotional impact

This thesis covers 12 years of experience in treating patients with congenital capillary malformations, so called port wine stains (PWS). The wide variation in treatment response to laser therapy has developed a profound need for the development of objective devises to measure treatment outcome, so that the maximum effectiveness of therapy can be achieved without unnecessary treatments. The purpose has been to better characterise PWS with the emphasis on blood flow, erythema, depth, so that the results of the treatment can be better (if possible) predicted, followed, documented and improved. We found that laser doppler imaging (LDI-a new technique) in the measurement of blood flow in PWS was more useful in research settings than as a predictive tool. Reflectance spectrophotometry has been superior to LDI in the prediction of the outcome of PWS therapy. It is objective and correlates well with clinical results and is also portable and easy to use. Skin ultrasound can help to characterise the PWS in the majority of patients and may help to predict the outcome of PDL treatment. With the help of special questionnaires, developed in collaboration with a child and adolescent psychiatrist, we have investigated the psychological and psychosocial impact a PWS can have on the individual according to the individual themselves or their family members. There is a high risk of developing negative parameters e.g. low self- esteem, school problems and difficulties in social relationships if you have a PWS, but the majority of these negative parameters can improve after the treatments

Ill-health in children withdyslexia : – an issue for school nurses

Dyslexi innebär problem med att läsa och skriva. Problemet är vanligt och cirka fem till tio procent av alla skolbarn beräknas ha dyslexi. Dyslexi är ett funktionshinder som ofta leder till ohälsa hos skolbarn. Ohälsan är svårtolkad och skolsköterskan har en viktig roll i att förebygga, upptäcka samt minska konsekvenserna av funktionshindret. Syftet med studien var att identifiera tecken på ohälsa hos barn med dyslexi och vilka faktorer som påverkar ohälsan. Studien genomfördes som en litteraturstudie där 11 vetenskapliga artiklar granskades. Resultatet visade att barn med dyslexi hade betydligt fler emotionella, psykosociala och beteende problem. Barnens självkänsla var låg, de blev ofta mobbade och skolsituationen upplevdes som jobbig. För att må bra utvecklade barnen mer eller mindre bra strategier. Positivt för barnen var att ha kamrater, föräldrar och lärare som förstod dem, ha en egen positiv attityd samt att vara duktig på något som inte hade med läsning att göra. För att förebygga ohälsa bör barnen tidigt och med hjälp av specialpedagogiska metoder för dyslektiker lära sig att läsa och skolsköterska bör utveckla rutiner för att snabbt och tidigt upptäcka ohälsa.Dyslexia implicates problems with reading and writing. The problem is common and approximately five to ten percent of all schoolchildren are estimated to have dyslexia. Dyslexia is a disability that often leads to ill-health among schoolchildren. Ill-health is difficult to interpret and the school nurse has an important role to prevent, detect and to reduce the impact of the disability. The purpose of this study was to identify signs for ill-health seen in children with dyslexia and what factors that affect the ill-health. This study was conducted as a literature review in which 11 scientific articles were reviewed. The results showed that children with dyslexia had significantly more emotional, psychosocial and behavioural problems. The children's self-esteem was low, they were often bullied and the school situation was perceived as annoying. In order to feel good have the children developed more or less successful strategies. Positive for the children was to have friends, parents and teachers who understand them, have a positive attitude and be good at something that not had to do with reading. In order to prevent ill-health should the children early get help of special teaching methods for dyslexics and the school nurse would develop procedures for a rapid and early detection of ill-health

Charles Troilius, London, to James Edward Smith, Norwich, [Norfolk]

Negotiates price for translating Linnaeus' travel journal [for Smith's "Lachesis Lapponica"]; difficulties of such an undertaking, including impact on his personal time and uncertainty how many folios it will fill. Encloses list of members of the Royal Swedish Academy of Sciences for the year 1803 [extant]. Notes on some of the members. Handwritten list of the members of the Royal Swedish Academy of Sciences for the year 1803 [8 pp]