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  • ISSN: 2379-0911
    Volume 5, Issue 2
    Research Article
    Joseph Losh*, Ken Waxman, Evan Slater, Robert Ouwendijk, Daniel Kim, Milcah Larks, Emma Huebner, and Shawn Steen
    Certain breast cancers that over-express HER2Neu (H2N) are now considered for neo-adjuvant chemotherapy using dual anti-H2N targeted drugs. Since January of 2013, 14 women with H2N over-expressed breast cancer were treated with a regimen including trastuzumab (Herceptin) and pertuzumab (Perjeta) prior to definitive surgery in our institution. 7 of 14 (50%) were estrogen receptor negative (ER-/H2N+) while the other 50% were ER+/H2N+. 9 of 14 (64%) had six cycles of chemotherapy prior to surgery while the remaining had four or five cycles prior to surgery. 9 of 14 (64%) had a mastectomy while 5 of 14 (36%) had breast conserving therapy. Final pathology showed that 50% had a complete pathologic response (pCR), while the remaining patients all had a significant partial response. Patients who received all six neo-adjuvant cycles had a higher rate of pCR. 6 of 14 (43%) patients had full axillary lymph node dissections (ALND); only 2 of the 6 (33%) contained residual tumor. 7 of 14 (50%) patients had sentinel lymph node biopsies (SLNB) done during definitive surgery. No SLNB specimens contained tumor. We observed a very low rate of residual axillary nodal disease suggesting that ALND may not always be necessary in these cases.
    Review Article
    Gemma Armstrong*, Andrew Smith, and Giles Toogood
    Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures performed globally but continues to carry to an unacceptably high risk of iatrogenic bile duct injury (BDI). In recent years several centres have proposed Near Infrared Fluorescent Cholangiography (NIRFC) with Indocyanine Green (ICG) as a potential method of dynamic intraoperative extra hepatic bile duct mapping. We provide an overview of the current problem of BDI during laparoscopic cholecystectomy including the incidence, aetiology and medico legal ramifications. We also provide a short summary of the enduring argument for and against routine intraoperative cholangiogram (IOC) and we discuss the new technology of NIRFC with ICG in detail. We provide an informative summary of the small number of highly heterogeneous clinical trials of NIRFC with ICG currently available and briefly discuss limitations of the technology.
    Flies A, Becker R, and Kopf S*
    A profound understanding of the biomechanics of the knee joint is crucial in order to develop and improve treatments of knee disorders. Extensive computational and experimental studies showed that the highest contact stress during loading is on the medial tibiofemoral and lateral patellofemoral cartilage. In the tibiofemoral joint, cartilage thickness decreases especially in the region without coverage of the meniscus. Interestingly, average cartilage thickness of the femur did not decrease under loading. Cartilage deformation takes places during the first 20 seconds of loading and remains constant afterwards. In vivo and in vitro determined joint forces show great dispersion. They depend strongly from leg alignment (e.g. varus and valgus deformity), loading conditions (e.g. static or dynamic), activity (e.g. knee bending, single-leg standing) and bodyweight. Beside joint forces shear stress is one of the key contributors to osteoarthritis. Leg alignment and the medial meniscus are important in preventing cartilage damage. The external knee adduction moment is a good parameter to describe load distribution in the tibiofemoral joint and a starting point for treatment strategies (e.g. tibial osteotomy, valgus unloader braces). Ligament injuries are another factor leading to early development of OA. Regarding patellofemoral joint, under loading the patella moves in a more proximal and posterior position shows a medial tilt and less flexion. In healthy cartilage loading leads to an increase in temperature creating optimal conditions for the production of extracellular matrix. Under unloading cartilage thickness recovers. Regular physical activity conditions the cartilage in a way that it experiences less decrease under loading. However, the line between stimulation and degeneration is not yet definite.
    Case Report
    Andrea Sagona*, Angelica Della Valle, Emilia Marrazzo, Erika Barbieri, Lidija Antunovic, Luca Di Tommaso, Fiorenza De Rose, and Corrado Tinterri
    Male breast cancer (MBC) is a rare pathology. The known risk factors include radiation exposure, estrogen administration, and diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter syndrome. An increased risk of male breast cancer has been reported in families in which the BRCA2 mutation on chromosome 13q has been identified. In these report we describe a case of a 40 year-old Klinefelter Syndrome man who underwent Nipple sparing mastectomy, sentinel lymph node biopsy, axillary dissection and contra lateral prophylactic NSM for an invasive mixed ductal-lobular carcinoma of the breast.
    Clinical Image
    Vitorino Modesto dos Santos*, Victor Eduardo de Almeida e França, and Lister Arruda Modesto dos Santos
    This elderly man with diffuse connective tissue disease in outpatient clinical follow-up had an episode of generalized acute abdominal pain of great intensity associated with impairment of general condition, signs of peritoneal irritation, in addition to circulatory instability.
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