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Seder C.W.,Section of General Surgery | Sakwa M.P.,Section of Cardiovascular Surgery | Shannon F.L.,Section of Cardiovascular Surgery
Journal of Heart Valve Disease | Year: 2010

Ventricular myxomas are rare, accounting for less than 5% of all benign cardiac tumors. Although histologically benign, myxomas can be a source of significant morbidity and mortality. The case is presented of a left ventricular myxoma involving the posterior papillary muscle that was resected using a minimally invasive transmitral approach. A radical mitral valve reconstruction was performed, including the replacement of two chordae tendineae, annuloplasty and valvuloplasty, resulting in excellent postoperative mitral valve function. Precise preoperative imaging and surgical planning are necessary to achieve adequate tumor margins and to minimize the likelihood of recurrence. © Copyright by ICR Publishers 2010.

Jain S.A.,University of Florida | Manchio J.V.,Section of General Surgery | Weinzweig J.,Chicago Center for Plastic and Reconstructive Surgery
Journal of Craniofacial Surgery | Year: 2010

Purpose: Frontal sinus fractures are relatively uncommon due to the high-impact force required to produce these. However, their management is quite complex, with the treatment algorithm incorporating many factors in which the status of the nasofrontal ducts is critically important. Traditionally, this has been evaluated by both axial and coronal computed tomographic (CT) scan views. Anatomically, we propose that this is better evaluated by coronal and sagittal CT views. We evaluated the role of sagittal CT scan views in determining the status of the nasofrontal ducts in patients with frontal sinus fractures. Methods: A retrospective analysis examining 8 patients with frontal sinus fractures, from August 2004 to January 2008, was performed. Axial, coronal, and sagittal CT scan views were obtained routinely as part of the facial trauma workup. These views were assessed to determine the status of the nasofrontal ducts. The operative findings were also reviewed. Results: Five of the 8 patients had displaced anterior and posterior table frontal sinus fractures. Of these, 4 required surgical intervention that included addressing the nasofrontal ducts. Two of the 8 patients had displaced anterior table fractures that required no intervention of the nasofrontal ducts. One patient had nondisplaced anterior and posterior table fractures and did not require surgery. The sagittal CT view clearly demonstrated the anatomy of the nasofrontal ducts in all 8 patients, including patients in whom the axial and/or coronal views were questionable. Intraoperatively, where the patency of the nasofrontal ducts was directly evaluated, there was a direct correlation with the sagittal image findings. Conclusions: The sagittal CT view provides invaluable information for evaluating the patency of the nasofrontal ducts in frontal sinus fractures. The ability to evaluate the frontal sinus in an anteroposterior dimension (the usual vector of the injury) and in a superoinferior dimension (the anatomic pathway of the ducts) is the reason for this imaging advantage. Copyright © 2010 by Mutaz B. Habal, MD.

Tan W.,Cancer Center | Boughey J.C.,Mayo Medical School | McNeil R.B.,Biostatistics Unit | Coppola K.E.,Mayo Medical School | And 3 more authors.
Oncologist | Year: 2010

Long-term outcomes and hence the role of adjuvant therapy in patients with small (≤1 cm), node-negative breast cancer remain unclear. This study's objective was to evaluate whether human epidermal growth factor receptor (HER)-2 status is an independent, poor prognostic marker in patients with these tumors and to identify a subgroup of patients with these small tumors who might benefit from adjuvant systemic therapy. All patients with a diagnosis of a node-negative breast tumor measuring ≤1 cm and available HER-2 test results between January 1, 2001, and December 31, 2005, at the three Mayo Clinic sites were identified. Clinicopathologic data were compared in three groups: HER-2-, HER-2-, and triple-negative (TN) tumors. Of the 421 tumors identified, 364 (86.5%) were HER-2+, 28 (6.7%) were HER-2[1], and 29 (6.9%) were TN. The median follow-up time was 1,015 days (range, 1-2,549 days). Groups were balanced in terms of patient age and tumor histology. Eleven patients with HER-2 tumors (3.0%), seven with HER-2- tumors (25.0%), and eight with TN tumors (27.6%) received adjuvant chemotherapy. Follow-up data were available for 357, 28, and 28 patients in the three groups, respectively. Death rates in the three groups were 6.4% (23 of 357) (one recurrencerelated death), 0% (0 of 28), and 7.1% (2 of 28) (one recurrence-related death), respectively. During followup, the tumor recurred in nine patients: four were HER-2 tumors (1.1%), two were HER-2+ tumors (7.1%), and three were TN tumors (10.7%). Patients with small, node-negative breast tumors have an excellent prognosis, but HER-2+and TN tumors appear to have a higher recurrence rate, warranting consideration for broad use and optimization of systemic adjuvant treatments. © AlphaMed Press.

Temur I.,Kafkas University | Ulker K.,Kafkas University | Sulu B.,Kafkas University | Karaca M.,Kafkas University | And 2 more authors.
Clinical and Experimental Obstetrics and Gynecology | Year: 2011

Nabothian cysts generally being small-sized and multiple are common gynecopathological conditions of women in reproductive age. We report a case of a giant nabothian cyst compressing the rectum apparently without gynecologic symptoms. Initial symptoms of pain and difficulty in defecation due to compression on the rectal wall because of the huge size of the cyst might be the first case in the literature. We made the differential diagnosis from adenoma malignum (minimal-deviation adenocarcinoma) by using immunhistochemical and histopathological techniques.

Pockaj B.A.,Mayo Medical School | Wasif N.,Mayo Medical School | Dueck A.C.,Mayo Medical School | Wigle D.A.,Mayo Medical School | And 7 more authors.
Annals of Surgical Oncology | Year: 2010

Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look. © 2010 Society of Surgical Oncology.

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