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Ashoor A, Lissidini G, Datta U, Bertoldi L, Veronesi P, Tan MLH. ASO Visual Abstract: Chyle Leak After Axillary Node Clearance in Breast Cancer Surgery: A Rare Complication and a Proposed Management Strategy from the British and Italian Experience. Ann Surg Oncol 2022; 29:8001. [PMID: 36057904 DOI: 10.1245/s10434-022-12412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Arwa Ashoor
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
| | - Germana Lissidini
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Uttaran Datta
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Lorenzo Bertoldi
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Melissa Ley-Hui Tan
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK
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Ashoor A, Lissidini G, Datta U, Bertoldi L, Veronesi P, Tan MLH. Chyle Leak After Axillary Node Clearance in Breast Cancer Surgery-A Rare Complication and a Proposed Management Strategy from the British and Italian Experience. Ann Surg Oncol 2022; 29:7992-7999. [PMID: 35849297 DOI: 10.1245/s10434-022-12094-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chyle leak after axillary surgery is a rare complication that lacks consensus and management guidelines. This study aimed to present the experiences of two centers in chyle leak management after axillary node clearance for breast cancer. Furthermore the authors provide a review of its pathophysiology and clinical diagnostic methods. They compare approaches for management of the axilla with those for other locations. METHODS A multicentre case series descriptive analysis of chyle leak after breast cancer axillary node clearance between 1 January 2013 and 31 May 2020 was performed. RESULTS The center in the United Kingdom and the center in Italy performed 655 and 4969 axillary node clearances, respectively. Four patients experienced chyle leaks. All the leaks had left-sided surgery (3 patients had level 3 clearances with mastectomy and implant-based breast reconstructions; 1 patient had level 2 clearance with therapeutic mammoplasty). All the leaks appeared within 3 days after surgery. Leak duration was between 11 and 29 days. The maximum daily output was 600 mL. All the leaks were treated conservatively with nutritional team support together with close drainage monitoring. The management strategy included a low-fat diet, a high-protein diet, total parenteral nutrition, and medium chain triglyceride supplements, as well as other elements. No negative effects on oncoplastic and reconstructive breast surgery wound-healing and no delays in adjuvant treatment were observed. CONCLUSION The incidence of chyle leak after breast cancer axillary node clearance was 0.07%. Early diagnosis and close monitoring together with conservative management involving nutritional team support can result in successful treatment of chyle leak without negative sequalae of breast cancer oncologic treatment.
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Affiliation(s)
- Arwa Ashoor
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
| | - Germana Lissidini
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, 20141, Milan, Italy
| | - Uttaran Datta
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Lorenzo Bertoldi
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, 20141, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20133, Milan, Italy
| | - Melissa Ley-Hui Tan
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK
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Ashoor A, Lissidini G, Datta U, Bertoldi L, Veronesi P, Tan MLH. ASO Author Reflections: Chyle Leak after Axillary Node Clearance in Breast Cancer Surgery, a Successful Management Approach from Leading Centres. Ann Surg Oncol 2022; 29:8000. [PMID: 35810225 DOI: 10.1245/s10434-022-12122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Arwa Ashoor
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
| | - Germana Lissidini
- Breast Surgery Department, European Institute of Oncology, Milan, Italy
| | - Uttaran Datta
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Lorenzo Bertoldi
- Breast Surgery Department, European Institute of Oncology, Milan, Italy
| | - Paolo Veronesi
- Breast Surgery Department, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Faculty of Medicine, University of Milan, Milan, Italy
| | - Melissa Ley-Hui Tan
- Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Pellini F, Bertoldi L, Deguidi G, Perusi N, Caldana M, De Flaviis M, Di Paolo S, Mirandola S, Tombolan V, Zambelli Sopalu S, Invento A. The use of indocyanine green as the only tracer for the identification of the sentinel lymph node in breast cancer: safety and feasibility. Gland Surg 2022; 11:1139-1147. [PMID: 35935557 PMCID: PMC9346226 DOI: 10.21037/gs-21-609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Sentinel lymph node biopsy (SLNB) is now considered the “gold standard” for axillary staging in the treatment of breast cancer. Most of the lymph node mapping experiences have been performed with a radioisotope (albumin-Tc99m) associated or not with the intraoperative injection of a dye, such as Patent-Blue V. Recent studies have shown how the use of indocyanine green (ICG; a drug used for diagnostic use for many years in other sectors) as a fluorescent tracer, allows to obtain alone detection rate of the sentinel lymph node similar or even better, without the risks related to radioactivity and with better use of resources. Methods From March 2020 to February 2021, 184 patients with breast cancer cN0, candidate for SLNB were enrolled at the Complex Operative Unit (UOC) of Breast Surgery, Breast Unit of the Hospital of Verona. The ICG was injected into the periareolar site and was used the NOVADAQ SPY Elite system (Stryker®) for transcutaneous intraoperative observation of fluorescence. The primary objective of the study is the evaluation of the feasibility of the technique and its sensitivity in the identification of sentinel lymph node; among the secondary endpoints the recognition of predictive factors on the identification (t1-t0) and extraction (t2-t1) times of the sentinel lymph node, and on the number of lymph node uptake pathways. Finally, was analyse the safety of the technique. Results The sentinel lymph node was detected and removed in 98.3%. The average number of sentinel lymph nodes extracted is 1.527, while the average number of total lymph nodes (TLNs) extracted is 3.375. The sensitivity of the sentinel lymph node detection technique with ICG, turns out to be 100%. Finally, in the literature, lymphatic function decreases with increasing age, reducing the identification rate of the SLN; this is not confirmed in our study. Conclusions Our study confirms the use of the only ICG tracer for SLNB in cN0 breast cancer, demonstrating that it is a safe, effective and sensitive technique, which also allows to reduce costs, risks and organizational efforts.
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Pappalardo F, Bertoldi L, Reichenspurner H, Bernhardt A. Left Ventricular Assist Devise Implantation after Extracorporeal Membrane Oxygenation Therapy and Subsequent Impella 5.0 Therapy—A Multicenter Analysis. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F. Pappalardo
- DGTHG-Vita Salute San Raffaele University, Advanced Heart Failure and MCS Program, Milan, Italy
| | - L. Bertoldi
- DGTHG-Vita Salute San Raffaele University, Advanced Heart Failure and MCS Program, Milan, Italy
| | - H. Reichenspurner
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
| | - A. Bernhardt
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
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Frigerio M, Bertoldi L, Giglio A, Perna E, Ammirati E, Cipriani M, Garascia A, Foti G, Masciocco G, Gagliardone MP, Russo C, Camici P. P2807Repeated levosimendan infusions or LVAD as a bridge to transplantation: 2-year results. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Frigerio
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - L Bertoldi
- University Vita-Salute San Raffaele, Milan, Italy
| | - A Giglio
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - E Perna
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - E Ammirati
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - M Cipriani
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - A Garascia
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - G Foti
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - G Masciocco
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | | | - C Russo
- Niguarda Hospital, DeGasperis CardioCenter, Milan, Italy
| | - P Camici
- University Vita-Salute San Raffaele, Milan, Italy
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Anglani F, Terrin L, Brugnara M, Battista M, Cantaluppi V, Ceol M, Bertoldi L, Valle G, Joy MP, Pober BR, Longoni M. Hypercalciuria and nephrolithiasis: Expanding the renal phenotype of Donnai-Barrow syndrome. Clin Genet 2018. [PMID: 29532936 DOI: 10.1111/cge.13242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Whole exome sequencing detected novel likely pathogenic variants in LRP2 gene in 2 patients presenting with hearing and vision loss, and the Dent disease (DD) classical renal phenotype, that is, low molecular weight proteinuria (LMWP), hypercalciuria and nephrocalcinosis/nephrolithiasis. We propose that a subset of patients presenting as DD may represent unrecognized cases or mild forms of Donnai-Barrow/facio-oculo-acustico-renal (DB/FOAR) syndrome or be on the phenotypic continuum between the 2 conditions.
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Affiliation(s)
- F Anglani
- Clinical Nephrology Division, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - L Terrin
- Clinical Nephrology Division, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Brugnara
- Pediatric Division, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - M Battista
- Nephrology and Transplantation Division, Department of Clinical and Experimental Medicine, Amedeo Avogadro University, Novara, Italy
| | - V Cantaluppi
- Nephrology and Transplantation Division, Department of Clinical and Experimental Medicine, Amedeo Avogadro University, Novara, Italy
| | - M Ceol
- Clinical Nephrology Division, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - L Bertoldi
- CRIBI Biotechnology Centre, University of Padua, Padua, Italy
| | - G Valle
- CRIBI Biotechnology Centre, University of Padua, Padua, Italy
| | - M P Joy
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B R Pober
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Longoni
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- L Bertoldi
- Section of Orthopedics and Traumatology, Ospedale Civile di Fiemme, Cavalese, Trento, Italy
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Abstract
The authors present a case of fracture dislocation of the ankle with the fibula entrapped behind the tibia--Bosworth's fracture. It is often unrecognized as such because it is so rare and because radiographs are not correctly interpreted. A stable reduction can be obtained by closed treatment when promptly recognized.
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Affiliation(s)
- M Molinari
- Section of Orthopedics and Traumatology, Ospedale di Fiemme, Cavalese (Tn), Italy
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