The Breast : official journal of the European Society of Mastology
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Randomized Controlled Trial Comparative Study
Pharyngo-laryngeal discomfort after breast surgery: comparison between orotracheal intubation and laryngeal mask.
Sore throat and dysphonia are a significant source of postoperative discomfort for patients scheduled for breast surgery who have been intubated for general anaesthesia. The aim of this study was to compare the incidence of postoperative pharyngo-laryngeal pain and dysphonia in the use of the laryngeal mask airway (LMA) or tracheal intubation in these patients. In a prospective, double-blind, randomised clinical trial we studied 53 women undergoing elective breast surgery to test the hypothesis that the use of the LMA could reduce the incidence of pharyngo-laryngeal morbidity compared with tracheal intubation. ⋯ The incidence of postoperative sore throat was significantly higher in the case of tracheal intubation at 6h (74% vs. 27%, p=0.0003) and at 24h (27% vs. 0%, p=0.004). The incidence of hoarseness was significantly higher in the tracheal intubation group than in the LMA group at 6h after surgery (40% vs. 15%, p=0.04), but not at 24h. Compared with tracheal intubation, the use of the LMA is associated with a lower incidence of postoperative sore throat and hoarseness and may contribute for improving patient comfort after breast surgery.
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Case Reports
Prolonged trastuzumab therapy in a patient with recurrent breast cancer and anthracycline-induced cardiac failure.
Current practice precludes patients with pre-existing cardiac dysfunction from trastuzumab therapy. A 57-year-old patient with HER2 positive metastatic breast cancer and anthracycline-induced cardiac failure was safely treated with trastuzumab. ⋯ She remains disease free and asymptomatic from cardiac dysfunction more than 6 years following breast cancer recurrence. We review the evidence for the use of trastuzumab in patients with controlled cardiac dysfunction, and suggest this group of patients should be considered for treatment with trastuzumab if no other or only less efficacious therapeutic options are available.
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Comparative Study
Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group.
Sentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined the impact on shoulder mobility of node positive patients having a secondary axillary dissection because of the findings of metastases postoperatively. ⋯ Node negative patients operated with sentinel lymph node biopsy have less arm morbidity compared with node negative patients operated with axillary lymph node dissection. Node positive patients who had a secondary axillary lymph node dissection after sentinel lymph node biopsy had no difference in either objective or subjective morbidity compared with node positive patients having a one-step axillary dissection.
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Recent evidence shows aromatase inhibitors (AIs) to be of benefit over tamoxifen in the adjuvant setting. It is also apparent that musculoskeletal symptoms associated with AIs may be a significant problem in the clinical setting. The aim of this article is to review the data on AIs with respect to musculoskeletal symptoms in the adjuvant setting. ⋯ AIs offer a significant advantage over tamoxifen. More research is required to ascertain the cause and to define the spectrum of musculoskeletal symptoms reported in women taking AIs. Decision of appropriate treatment should be made jointly between clinician and patient after full discussion of the risks and benefits.
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Controlled Clinical Trial
Prospective evaluation of concomitant tumour bed boost with whole breast irradiation in patients with locally advanced breast cancer undergoing breast-conserving therapy.
To evaluate prospectively the feasibility of concomitant weekly tumour bed electron boost along with whole breast radiotherapy (RT) following breast-conserving therapy (BCT) in patients with locally advanced breast cancer (LABC) with the aim of reducing overall treatment time. ⋯ Concomitant tumour bed boost along with whole breast RT appears to be safe and feasible in a select group of patients. As the treatment is completed earlier by 6-10 days than conventional practice, it has favourable time and resource implications, particularly attractive for patients travelling long distances for treatment. Based on these encouraging results, we are planning to confirm the results in an appropriately designed and powered randomised trial.