The incidence of breast cancer is still increasing, and with improved cancer treatment, more women live longer with the side effects of their treatment. The response of normal tissue to radiation continues for years a...The incidence of breast cancer is still increasing, and with improved cancer treatment, more women live longer with the side effects of their treatment. The response of normal tissue to radiation continues for years after the treatment is completed. The influence of radiotherapy on the outcome of breast reconstructtive surgery remains unpredictable. The combination of two surgical sites of which one is previously irradiated, is rarely encountered in humans and thus compiles a unique opportunity to study the implications of irradiation followed by surgery. The aim of this study was to examine the long-term effect of radiation therapy on the proteins expressed in the wound tissue after a breast reconstruction. Ten patients were included in the study, all treated with radiotherapy after a mastectomy and breast reconstruction with a contralateral pedicled TRAM flap. Expanded poly-tetrafluoretylene polymer tubes were implanted for 10 days, subcutaneously, below the inframammary fold and below the donor site. The protein from the newly synthesized granulation tissue in the tubes was extracted and analyzed for differences in protein expression with 2D gel electrophoresis and mass spectrometry. A total of 676 proteins were detected;of these, 4 proteins changed significantly and were successfully identified. TPM4 and APOA4 from the radiation treated tissue were shown to be significantly decreased, whereas IGKC and VDAC1 were found to be significantly increased. The proteomic technique combined with the ePTFE tube wound model can elucidate some of the molecular alterations in the wound healing induced by radiation therapy. The protein modifications of TPM4, APOA4, IGKC and VDAC1 may influence the cell proliferation, apoptosis and the inflammation of the tissue repair process.展开更多
目的:探讨利用背阔肌皮瓣、腹直肌肌皮瓣(r ect us abdomi ni s myocut aneous f l ap,TRAM),假体或者联合使用开展保留乳房外形的乳腺手术的手术适应证,方式选择,手术并发症。方法:2007年5月至2009年2月行背阔肌皮瓣,腹直肌皮瓣,假体,...目的:探讨利用背阔肌皮瓣、腹直肌肌皮瓣(r ect us abdomi ni s myocut aneous f l ap,TRAM),假体或者联合使用开展保留乳房外形的乳腺手术的手术适应证,方式选择,手术并发症。方法:2007年5月至2009年2月行背阔肌皮瓣,腹直肌皮瓣,假体,以及联合使用的保留乳房外形的乳腺手术21例。观察指标包括手术方式的选择,手术时间,术后并发症以及美学效果。结果:背阔肌皮瓣改良保乳术12例,平均时间289mi n;腹直肌皮瓣改良保乳术4例,平均时间393 mi n。利用腹直肌和背阔肌皮瓣修复乳癌术后胸壁巨大缺损1例。Paget病利用腹直肌和背阔肌皮瓣行乳房再造术1例。乳癌术后行游离腹直肌皮瓣乳房再造术1例。保留皮肤乳头乳晕全切术后背阔肌乳房再造术1例。乳房全切后乳房即刻再造术1例。再造乳房有2例失败,其余乳房存活良好,手术并发症少。结论:利用自体组织或者假体行改良保乳术或者乳房再造术,操作时间不长,术后并发症少,美学效果好,基本不影响患者的后期治疗。展开更多
A 59-year-old woman presented with erythema and pruritis of the breast 4.5 years after undergoing lumpectomy and radiation for breast cancer. Biopsy confirmed a diagnosis of angiosarcoma. This tumor stained positive f...A 59-year-old woman presented with erythema and pruritis of the breast 4.5 years after undergoing lumpectomy and radiation for breast cancer. Biopsy confirmed a diagnosis of angiosarcoma. This tumor stained positive for CD34 as well as 70% Ki67 prior to therapy initiation. A multidisciplinary approach yielded a plan for neoadjuvant chemoradiation and surgical resection including delayed completion transverse rectus abdominis flap for tissue coverage. Neoadjuvant therapy successfully decreased rates of cellular proliferation, as reflected by a Ki67 of 5%, at the time of resection. Pathophysiologically, angiosarcomas may be very aggressive and may develop following radiation for breast cancer. Such tumors may become more common as breast cancer therapies, which frequently include radiation therapy, improve with time. Early recognition of angiosarcoma is imperative for successful therapy. These tumors may present with a wide range of symptoms, but may be asymptomatic. Surgical resection is the preferred therapy, but early recognition is critical.展开更多
文摘The incidence of breast cancer is still increasing, and with improved cancer treatment, more women live longer with the side effects of their treatment. The response of normal tissue to radiation continues for years after the treatment is completed. The influence of radiotherapy on the outcome of breast reconstructtive surgery remains unpredictable. The combination of two surgical sites of which one is previously irradiated, is rarely encountered in humans and thus compiles a unique opportunity to study the implications of irradiation followed by surgery. The aim of this study was to examine the long-term effect of radiation therapy on the proteins expressed in the wound tissue after a breast reconstruction. Ten patients were included in the study, all treated with radiotherapy after a mastectomy and breast reconstruction with a contralateral pedicled TRAM flap. Expanded poly-tetrafluoretylene polymer tubes were implanted for 10 days, subcutaneously, below the inframammary fold and below the donor site. The protein from the newly synthesized granulation tissue in the tubes was extracted and analyzed for differences in protein expression with 2D gel electrophoresis and mass spectrometry. A total of 676 proteins were detected;of these, 4 proteins changed significantly and were successfully identified. TPM4 and APOA4 from the radiation treated tissue were shown to be significantly decreased, whereas IGKC and VDAC1 were found to be significantly increased. The proteomic technique combined with the ePTFE tube wound model can elucidate some of the molecular alterations in the wound healing induced by radiation therapy. The protein modifications of TPM4, APOA4, IGKC and VDAC1 may influence the cell proliferation, apoptosis and the inflammation of the tissue repair process.
文摘目的:探讨利用背阔肌皮瓣、腹直肌肌皮瓣(r ect us abdomi ni s myocut aneous f l ap,TRAM),假体或者联合使用开展保留乳房外形的乳腺手术的手术适应证,方式选择,手术并发症。方法:2007年5月至2009年2月行背阔肌皮瓣,腹直肌皮瓣,假体,以及联合使用的保留乳房外形的乳腺手术21例。观察指标包括手术方式的选择,手术时间,术后并发症以及美学效果。结果:背阔肌皮瓣改良保乳术12例,平均时间289mi n;腹直肌皮瓣改良保乳术4例,平均时间393 mi n。利用腹直肌和背阔肌皮瓣修复乳癌术后胸壁巨大缺损1例。Paget病利用腹直肌和背阔肌皮瓣行乳房再造术1例。乳癌术后行游离腹直肌皮瓣乳房再造术1例。保留皮肤乳头乳晕全切术后背阔肌乳房再造术1例。乳房全切后乳房即刻再造术1例。再造乳房有2例失败,其余乳房存活良好,手术并发症少。结论:利用自体组织或者假体行改良保乳术或者乳房再造术,操作时间不长,术后并发症少,美学效果好,基本不影响患者的后期治疗。
文摘A 59-year-old woman presented with erythema and pruritis of the breast 4.5 years after undergoing lumpectomy and radiation for breast cancer. Biopsy confirmed a diagnosis of angiosarcoma. This tumor stained positive for CD34 as well as 70% Ki67 prior to therapy initiation. A multidisciplinary approach yielded a plan for neoadjuvant chemoradiation and surgical resection including delayed completion transverse rectus abdominis flap for tissue coverage. Neoadjuvant therapy successfully decreased rates of cellular proliferation, as reflected by a Ki67 of 5%, at the time of resection. Pathophysiologically, angiosarcomas may be very aggressive and may develop following radiation for breast cancer. Such tumors may become more common as breast cancer therapies, which frequently include radiation therapy, improve with time. Early recognition of angiosarcoma is imperative for successful therapy. These tumors may present with a wide range of symptoms, but may be asymptomatic. Surgical resection is the preferred therapy, but early recognition is critical.
