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Central venous access devices play an integral role in providing long-term venous access. Percutaneous and cut-down techniques have been used with varying complications. Between January 1998 and July of 2001, 358 venous access devices were placed at Albert Einstein Medical Center in Philadelphia, Pennsylvania. A retrospective study was performed to compare complications and operative times for 2 methods of catheter insertion. Overall complication rate was 14%. In lines successfully placed percutaneously, the complication rate was 15% (25 of 163) compared with 11% (16 of 148) in the successful cephalic cut-down group, P = .11. Complications including—pneumothorax, late catheter transection, and bradycardia—only occurred in percutaneously placed lines. Mean operative times were similar for both groups. Use of the cut-down approach for long-term venous access may result in improved patient safety. The cut-down technique should be considered a safe initial approach for placement of venous access devices.

There is a significant body of data that suggests that achieving negative margins is essential for local control.1 Numerous studies have also suggested a negative financial and social impact associated with the need for re-excision.2 Most surgeons agree that achieving negative margins at the initial surgery can significantly improve cosmetic outcome as well. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stages I and II invasive breast cancer. Cost analysis of a surgical consensus guideline in breast-conserving surgery.

Objective The aim of this study was to determine the impact of the results of the 12-gene DCIS Score assay on (i) radiotherapy recommendations for patients with pure ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS), and (ii) patient decisional conflict and state anxiety. Methods Thirteen sites across the US enrolled patients (March 2014–August 2015) with pure DCIS undergoing BCS. Prospectively collected data included clinicopathologic factors, physician estimates of local recurrence risk, DCIS Score results, and pre-/post-assay radiotherapy recommendations for each patient made by a surgeon and a radiation oncologist. Patients completed pre-/post-assay decisional conflict scale and state-trait anxiety inventory instruments. Results The analysis cohort included 127 patients: median age 60 years, 80 % postmenopausal, median size 8 mm (39 % ≤5 mm), 70 % grade 1/2, 88 % estrogen receptor-positive, 75 % progesterone receptor-positive, 54 % with comedo necrosis, and 18 % multifocal. Sixty-six percent of patients had low DCIS Score results, 20 % had intermediate DCIS Score results, and 14 % had high DCIS Score results; the median result was 21 (range 0–84). Pre-assay, surgeons and radiation oncologists recommended radiotherapy for 70.9 and 72.4 % of patients, respectively. Post-assay, 26.4 % of overall recommendations changed, including 30.7 and 22.0 % of recommendations by surgeons and radiation oncologists, respectively. Among patients with confirmed completed questionnaires ( n  = 32), decision conflict ( p  = 0.004) and state anxiety ( p  = 0.042) decreased significantly from pre- to post-assay. Conclusions Individualized risk estimates from the DCIS Score assay provide valuable information to physicians and patients. Post-assay, in response to DCIS Score results, surgeons changed treatment recommendations more often than radiation oncologists. Further investigation is needed to better understand how such treatment changes may affect clinical outcomes.

Carcinoid tumors of the breast have been described in the literature. The diagnosis is made by identification of typical histologic features and confirmed by a positive argyrophilic reaction or the presence of neurosecretory granules. There are several theories of the pathogenesis of carcinoid tumors in the breast and controversy as to whether these tumors actually originate in the breast ducts or are tumors that arise from neuroectodermal cells that have migrated to the breast ducts. Historically, treatment of carcinoid of the breast has been by mastectomy. We report three cases of primary carcinoid tumor of the breast treated with lumpectomy and axillary node dissection. No adjuvant radiation or systemic treatment was administered. In all three cases, no metastases were identified in lymph nodes sampled and all patients have remained clinically free of recurrent disease. Decisions about the need for radiation or systemic treatment of breast carcinoid tumors depend on one's interpretation of the pathogenesis of this disease. Breast conservation is a surgical option that has not been previously reported. Larger series of carcinoid tumors of the breast, their treatment, and their follow-up are needed.

Family history is a significant risk factor for the development of breast cancer. The relative lifetime risk of breast cancer ranges from 1.4 for a woman whose mother was given a diagnosis of breast cancer after the age of 60 to 15.0 for a woman with an inherited mutant BRCA1 gene. 1 – 3 Breast cancer attributed to a family history of the disease has been reported to account for 6 to 19 percent of all cases of breast cancer. 1 , 4 Recently, two genes related to breast cancer ( BRCA1 and BRCA2 ) were identified. 5 – 7 Genetic-linkage studies of families with multiple . . .

Use this case-based text to prepare for any hand or wrist surgery! Thieme congratulates Kevin D. Plancher on being chosen by New York magazine for its prestigious Best Doctors 2015 list. From treating rheumatoid arthritis to tendon repair, this lavishly illustrated text examines nearly 100 cases of common elbow, hand and wrist surgeries as performed by leading experts. You will review techniques for treating compression neuropathy, amputations, arthroscopic procedures, joint reconstruction, and arthrodesis, demonstrated by high-quality, full-color intraoperative photographs, x-rays, and illustrations. A practical refresher when planning your operative strategy, as well as a useful general reference, the book offers such special features as: * More than 200 color illustrations that provide dynamic representations for easy visualization of techniques * Combines both trauma and elective surgery in one convenient volume * Pearls and pitfalls to help avoid complications and problems * Step-by-step descriptions of the newest techniques for carpal tunnel syndrome, arthroscopic assisted distal radius fixation, scaphoid percutaneous reduction, and more! * Each chapter written by experienced specialists who perform these surgeries on a daily basis Incorporating both outstanding graphics and clear, practical information, this book is a must for orthopedic surgeons, sports medicine specialists, emergency room physicians, trauma specialists, plastic surgeons, residents, and fellows. It is also an ideal way to prepare for the CAQ in hand surgery, and to \"confer\" with your colleagues on the most current and effective surgical techniques for the hand and wrist.