Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia

PURPOSE: The purpose of this study was to evaluate the effectiveness of radiofrequency thermal rhizotomy (RTR) for trigeminal neuralgia, after failure of pharmacological management. PATIENTS AND METHODS: Two hundred fifteen patients underwent RTR from 1991 to 1996 and were prospectively evaluated. These patients were characterized by age, sex, side of the face, and division(s) involved. Patients were evaluated for pain relief, recurrence requiring or not requiring reoperation, and the type and rate of complications. They were followed-up by serial clinical evaluation and telephone interview. Patients were categorized into groups: 1) Successful result: excellent, good pain relief; and 2) Unsuccessful result: fair, poor, or no pain relief. The RTR group was compared with historical controls. Follow-up ranged from 9 to 68 months (mean, 32 months) and results were evaluated at early and long-term follow-up. RESULTS: At early follow-up (defined as immediately postoperatively to 6 months), pain relief of excellent or good quality (successful result) occurred in 198 of 215 patients (92%). Fair or poor or no pain relief (unsuccessful result) occurred in 17 (8%) patients. At long-term follow-up (>6 months to 68 months), recurrence of pain that required reoperation occurred in 24 patients (11%) and recurrence of pain that did not require reoperation (medically managed) occurred in 34 patients (16%). Dysesthesia developed in 18 patients (8%); seven patients (3%) had dysesthesia alone (medically managed) and 11 patients (5%) had dysesthesia with recurrence of pain (medically or surgically managed). "Anesthesia/analgesia dolorosa" developed in four patients (1.8%) and was medically managed. At long-term follow-up, 83% of patients had good to excellent pain relief (successful result). There were no mortalities, no significant morbidity, and a low rate of minor complications. CONCLUSION: With the use of this specific diagnostic approach and management algorithm, patients with trigeminal neuralgia can be successfully managed.     

Effects of conjugated estrogens with or without medroxyprogesterone acetate on mammary carcinogenesis, uterine adenomyosis and femur in mice

The Authors report their experience in the treatment of twenty-one patients with intussusception operated in the Paediatric Surgery Division ASL FG/3 between January 1988 and December 1994. Eighty-nine percent of the patients were between 2 and 12 months of age, with a peak between 2 and 6 months (60%). Ultrasound allowed to identify the pathological picture in forty-two percent of the cases and diagnosis was confirmed by barium enema. In 8 patients a pathology more or less responsible of the intussusception or associated with it was detected. The time between the onset of symptoms and admission as well as the relation between intestinal resection and duration of symptomatology were analyzed. The resection rate was maximal (55%) in those patients presenting symptoms beyond 25 hours. Intestinal resection was performed in 9 patients (47%): 6 ileo-colic; 1 ileo-colic resection extended to the splenic flexure; and 2 ileo-ileal ones. In this series no postoperative complications or recurrences or deaths were registered. Long term results proved that ileo-colic resection, even in few-months old infants, is well tolerated.     

The results of a long-term follow-up for patients with stage Ta bladder cancer, especially regarding those with multiple recurrences

OBJECTIVE: We reviewed our series of stage Ta bladder cancer patients with a long-term follow-up in order to clarify the prognosis of these patients, especially those who have repeated recurrences. MATERIALS AND METHODS: A retrospective study was done on 88 patients with stage Ta bladder cancer who were treated between 1971 and 1990 at our hospital. All patients reviewed were followed up for at least 5 years. RESULTS: Fifty-three patients out of 88 had recurrence, and the number of recurrences ranged from one to eleven. In the first recurrence, the 5- and 10-year recurrence-free rates were 53.4% and 37.1%, respectively. In the second recurrence, those rates were 25.7% and 15.9%, respectively. Comparisons of the recurrence-free rates between the first recurrence and that of more than 2 times yielded statistically significance (p < 0.01). On the other hand, when the recurrence-free rates of those patients showing recurrence more than 2 times were compared no statistical significance was observed among them. In addition, most patients with multiple recurrences also tended to show a long tumor-free period at some point. In eight patients a stage-up of > or = T1 developed during the study period. No characteristics of the tumors, including the multiplicity of the recurrence, was found to correlate with the stage-up. CONCLUSIONS: Most patients with multiple recurrences demonstrated a long tumor-free period at some point, and, moreover, in some of those patients there was also a possibility that no further recurrence occurred. In addition, frequent recurrence was not associated with increased incidence of stage-up. Based on these findings, multiple recurrence is not thought to be an especially ominous sign, and therefore bladder-preserving therapy is indicated for such patients.     

Disease-free survival and recurrence after resection of colorectal carcinoma

Recurrence data from a series of 1,315 colorectal cancer patients managed by one surgeon with potentially curative resection are presented. Complete follow-up information was available on 1,287 (98%) patients. At the time of the last recurrences, 164 and 232 months for rectal and colonic tumours respectively, the long-time recurrence rate was significantly (P = 0.001) higher for rectal tumours (42%) than for colonic (33%). Although local recurrences tended to be more common in rectal than in colonic tumours (18% compared to 15%), only those in contiguity with the operative area were significantly (P less than 0.005) more common in rectal tumours. Systemic recurrences were also significantly (P less than 0.025) commoner for rectal tumours. The greater recurrence rates in rectal tumours were associated with significantly (P less than 0.001) higher incidence of stage C tumours shorter recurrence-free survival in rectal stage C tumours (P = 0.001) and higher incidence of pulmonary metastases (P less than 0.001).     

Mid-term results of the Ross procedure

BACKGROUND: We previously reported our experience using Mohs micrographic surgery (MMS) for 45 patients with lentigo maligna (LM) and lentigo maligna melanoma (LMM). The patients were treated between 1985 and 1992. In our initial publication, all of the patients were free of local disease and evidence of metastases at an average of 29.2 months after therapy. OBJECTIVE: The purpose of this study was to report long-term follow-up of our previously published data. METHODS: MMS was performed in 26 patients with LM and 19 patients with LMM using frozen sections followed by rush permanent sections. Follow-up was obtained by contacting the referring physician, examination by one of our two Mohs surgeons, or by contacting the patient or his or her family. RESULTS: After a median follow-up of 58.0 months (214.3 patient-years), there was one recurrence. This patient was a 56-year-old woman with five prior recurrences before MMS. Six patients were decreased of other causes during the study. CONCLUSIONS: MMS using frozen and rush permanent sections resulted in a 97% cure rate for LM and LMM. Because MMS minimizes the removal of normal tissue, and the cure rate exceeds that of conventional therapies, the authors recommend this technique for the treatment of LM and LMM.     

A reproducible method for automated extraction of brain volumes from 3D human head MR images

PURPOSE: To assess the frequency and prognosis of skin recurrences after breast-conserving therapy (BCT) compared with other breast recurrences. MATERIALS AND METHODS: From 1968 to 1986, 1,624 patients with unilateral stage I or II breast cancer treated with BCT at the Joint Center for Radiation Therapy (Boston, MA) underwent gross tumor excision and received a dose of > or = 60 Gy to the tumor bed. Skin recurrences (SR) were defined as breast recurrences without associated parenchymal disease. An invasive breast recurrence with any parenchymal disease noted clinically or radiographically was scored as an other breast recurrence (OBR). Median follow-up for survivors was 137 months. RESULTS: SR represented 8% (18 of 229) of all breast recurrences and occurred in 1.1% of all patients. The outcome after local recurrence was different for patients with SR and invasive OBR. Patients with SR more frequently had uncontrolled local failure (50%; 9 of 18) than did patients with OBR (14%; 26 of 188) (P = .0007). Forty-four percent (8 of 18) of patients with SR had distant metastasis simultaneously or within 2 months of the recurrence compared with 5% (9 of 188) of invasive OBR patients (P < .0001). For patients without distant metastasis at the time of recurrence, the 5-year actuarial rate of development of distant metastasis was 60% for SR patients compared with 39% for invasive OBR patients (P = .07), and the corresponding 5-year actuarial survival rates beyond the time of local failure were 51% and 79%, respectively (P = .06). CONCLUSION: In contrast to other types of invasive breast recurrence after breast-conserving therapy, skin recurrences are rare and are associated with a significantly higher rate of distant metastasis and uncontrolled local disease as well as a lower rate of survival.     

Perioperative transfusion, postoperative infection, and recurrence of head and neck cancer

BACKGROUND: Considering the high recurrence rate after conventional inguinal hernia repair, the totally preperitoneal endoscopic inguinal hernia repair has been used. METHODS: The present experience of the authors embraces 1085 patients with a total of 1717 inguinal hernias, including 200 recurrences. The operative technique is described with emphasis on pitfalls and tricks. RESULTS: Analysis of the data concerning the first 403 patients with 1 year complete follow-up reveals a mean (SEM) operating time of 42 (1.2) min for unilateral and 58 (1.0) min for bilateral hernia repair. Mean (SEM) postoperative hospital stay was 2 (0.04) days. Complication rates during and after operation were 0.3% and 3.3% respectively. The morbidity rate at 1 month after operation was 3.5%. The recurrence rate was 0.3% at 1-year follow-up. CONCLUSION: Totally preperitoneal endoscopic inguinal hernia repair is safe and reproducible for any type of primary or recurrent inguinal hernia, even in patients with previous subumbilical surgery or severe systemic disease. Careful follow-up is mandatory to assess the late recurrence rate.     

In vivo surface analysis of titanium and stainless steel miniplates and screws

OBJECTIVE: To determine the results peranal excision for rectal carcinoma. DESIGN: Retrospective case series. SETTING: A university-affiliated hospital. PATIENTS: Of 178 patients who presented for curative resection of rectal carcinoma between 1975 and 1993, 19 (10.7%) were deemed suitable for local excision. There were 10 men and 9 women with a mean age of 71.2 years. The follow-up ranged from 13 to 184 months. INTERVENTION: Peranal excision. MAIN OUTCOME MEASURES: Histologic differentiation, gross morphology, depth of invasion and size of the carcinoma, adequacy of margins of excision, complications of operation, rates of recurrence, results of salvage therapy and 5-year survival. RESULTS: There were no intraoperative complications. Postoperative complications included urinary retention (one patient) and bleeding (one patient). There were five local recurrences (26%). Salvage operations were performed in three (60%) patients and were successful in two of them. The 5-year cancer-specific survival rate was 82%. The recurrence rate was higher in patients with inadequate margins of excision and ulcerative lesions. Neither size nor grade of the carcinoma correlated with recurrence. CONCLUSIONS: Local excision of rectal carcinoma can be performed successfully in selected patients. Diligent follow-up is required, because up to 60% of local recurrences can be treated successfully.     

The value of double contrast colon imaging in inadequate colposcopic diagnosis

PURPOSE: Prospective evaluation of colon double-contrast enemas in patients with incomplete colonoscopy during routine examination. MATERIALS AND METHODS: From 1. February 1993 through 31. January 1994 we prospectively evaluated all patients undergoing a double-contrast barium enema following incomplete colonoscopy in the endoscopy unit of the Department of Surgery of the University Hospital Marburg. The examination was carried out using the typical double-contrast technique at least 24 h after colonoscopy. The results of the barium enema were correlated with the findings at colonoscopy with regard to completion of the diagnostic procedure and additional pathological findings. RESULTS: Of 448 colonoscopies 168 remained incomplete. Sixty patients underwent an additional double-contrast study of the colon. In 43 patients this study was sufficient to complete the diagnostic procedure. Unknown pathological diagnoses were found in 11 patients. In 2 patients an adenocarcinoma and in 9 patients polypoid lesions were detected. CONCLUSION: After incomplete colonoscopy a double-contrast barium enema should be performed to complete the diagnostic examination of the whole colon and to reveal unknown additional pathological findings.     

Decreased risk of subsequent colonic cancer in patients undergoing polypectomy after barium enema: analysis based on data from the preendoscopic era

OBJECTIVE: Published data from the Mayo Clinic gathered during the preendoscopic era were analyzed to show that the risk of subsequent colonic carcinoma is reduced in patients with benign-appearing polyps that are revealed by radiology who then undergo polypectomy. MATERIALS AND METHODS: Data from the Mayo Clinic gathered during a 6-year period before the availability of endoscopy were used to determine the effect on the subsequent risk of colonic carcinoma if the benign-appearing polyps initially revealed by radiology had been removed rather than left in place and followed up by serial barium enemas. Data were from 226 patients with benign-appearing polypoid lesions of the colon that were 1 cm in diameter or larger and had been followed up by periodic barium enemas. The period of radiologic surveillance was 12-229 months (mean, 68 months). Between two and 17 barium enemas (mean, 5.2) were performed on each patient. The clinical follow-up period was 12-242 months (mean, 140 months). RESULTS: Twenty-one adenocarcinomas developed at the site of the index polypoid lesion as found on follow-up barium enema examinations of these patients. Eleven additional adenocarcinomas of the colon were found at sites remote from that of the index lesion. If the index polyp had been removed when initially diagnosed radiologically, 66% fewer subsequent carcinomas would have occurred in these patients during the average of 11 years of clinical follow-up. CONCLUSION: Excision of benign-appearing polyps found on initial barium enema examinations would result in a significant decrease in the subsequent risk of colonic adenocarcinoma.     

Barium enema, proctosigmoidoscopy and upper gastrointestinal series in the preoperative evaluation of the cancer patient

Charts of 566 patients admitted to the Surgery Branch, National Cancer Institute over a five year period were reviewed. Routine upper gastrointestinal series was performed in 453 patients; barium enemas in 490; and proctosigmoidoscopies in 342. Upper gastrointestinal series detected no metastases or second primary malignancies but delineated the extent of large intra-abdominal tumors. Barium enema and proctosigmoidoscopy together revealed three unsuspected primary colonic tumors (1.2% in patients over 50 years of age). Sigmoidoscopy and examination of the stool for occult blood would have detected the same patients. Barium enema may be limited to surgical cancer patients in whom the extent of local tumor invasion is to be defined and to older patients in whom colonic tumors are suspected. Neither UGIS nor barium enema appear to be of value as a routine preoperative screening test in surgical cancer patients.     

The long-term outcome of central serous chorioretinopathy

OBJECTIVE: To assess the long-term outcome of central serous chorioretinopathy (CSR) among a group of patients who previously participated in a prospective argon laser photocoagulation study of CSR. DESIGN: Thirty-eight of 41 surviving patients with CSR participating in an earlier study were invited to participate in a follow-up study that included history taking, ophthalmoscopy, biomicroscopy, and fundus photography. RESULTS: Thirty-seven (38 eyes) of 38 surviving patients (97%) were available for follow-up between 11 and 15 years after participation in the earlier study. There were no clinically documented or historical recurrences of CSR among the six eyes previously treated by direct laser photocoagulation. There were 13 clinically documented recurrences and four historical recurrences among the 32 eyes not treated with direct laser photocoagulation. The difference in recurrences was statistically significant (P = .02). Pigment changes indistinguishable from age-related macular degeneration frequently occurred in eyes with CSR. The difference in the development of such pigment changes between eyes with CSR (33 of 38) and nonaffected fellow eyes (12 of 35) was significant (P = .001). CONCLUSIONS: The decreased rate of CSR recurrence after direct laser photocoagulation reported in an earlier study was sustained with follow-up beyond 10 years. Pigmentary changes in the fundus indistinguishable from those associated with age-related macular degeneration developed in eyes affected with CSR, probably as a consequence of the presence of subretinal fluid accompanying the CSR rather than from early age-related macular degeneration.     

Perianal abscess and fistula-in-ano in infants

PURPOSE: The aim of this study was to obtain insight into the short- and long-term results of treatment of perianal abscess and fistula-in-ano in infants. METHODS: This is a retrospective study of the records of patients treated over a 21-year period from January 1974 until December 1994 in a Pediatric Surgical Center. A long-term (1 to 24 year, mean 7.74 year) follow-up by questionnaire (response 81%) is also included. RESULTS: Drainage of a perianal abscess is followed in 35% of cases by a fistula. Fistulotomy or fistulectomy is followed in 13% of cases by a recurrence. There were two long-term recurrences that both healed spontaneously. The persisting scar sometimes gives problems with anal cleaning. All children aged 3 years and older were continent for feces. In two, there was soiling for some time. One had constipation and one was incontinent during the night. CONCLUSIONS: Simple drainage of a perianal abscess is followed frequently by a fistula. Fistulotomy or fistulectomy of a fistula-in-ano in infants has a reasonable chance of recurrence in the short term. Long-term recurrences are exceptional. There are no serious disabilities in the long run.     

Blood-flow sensing by anionic biopolymers

The purpose of this study was to compare local recurrence, distant metastases, and survival rate in 350 patients with cancer of the middle and low rectum who underwent a radical abdominoperineal resection (APER) or a sphincter-saving resection (SSR) in our Institute. There were 257 APER patients and 93 SSR patients, with a median follow-up of 77 months. At 5 years, the estimates in APER and SSR patients were respectively 11% and 30% for the incidence of pelvic recurrence, 18% and 8% for the incidence of distant metastases, and 64% and 73% for overall survival. In the multivariate analysis it was found that Dukes' stage significantly affected pelvic recurrences, distant metastases rate and overall survival; histologic type affected only the pelvic recurrence rate. However, the final outcome of patients following APER or SSR was similar, suggesting that local failure per se does not affect long-term survival.     

"Big Smoke" has big risks: daily cigar use causes cancer, heart disease

BACKGROUND: To study the behaviour of recurrent benign parotid tumours, recurrence characteristics and problems faced with the removal of these lesions. METHODS: We reviewed the charts of the work of a single surgeon between 1971 and 1996. RESULTS: There were 24 patients (13 women, 11 men) with a mean age of 44 years at re-operation. Mean follow-up period was 10 years (range 1-22 years). There were 21 recurrent pleomorphic adenomas, two monomorphic adenomas and one patient with recurrent oncocytoma. Nine patients had solitary recurrence with a mean size of 14 mm, 15 patients had multiple recurrences with a mean size of 8 mm. There was malignant transformation of a previously benign lump in one patient. Three patients presented with a second or third recurrence. Overall facial nerve paralysis was 53% (38% temporary and 15% permanent). Frey's syndrome occurred in four patients (17%). CONCLUSIONS: Recurrent benign parotid tumours are uncommon if superficial parotidectomy (SP) is the performed initially; recurrence rates are between 0-4%. The recurrences are usually slow growing and require lengthy follow-up. Pre-operative diagnosis of a lump in the region of previous excision is useful in treatment planning. Malignant transformation in previous benign lump should be considered and fine needle aspiration biopsy may help in diagnosis. Facial nerve injury is more likely if the tumour is deep, in multiple sites or involves extensive scar tissue. Radiotherapy is controversial, it should be considered if there has been tumour spillage following re-operation.     

Salivary duct carcinoma: a report of nine cases

We studied loco-regional recurrence during follow-up (median observation time 8 years) in 1,153 patients, who underwent modified mastectomy and were randomly assigned to one of the following postoperative treatments; Premenopausal patients: radiotherapy, cyclophosphamide, or both; Post-menopausal patients: radiotherapy, tamoxifen, or both. Recurrence occurred in a total of 419 patients, 123 of whom had loco-regional recurrence with or without distant metastasis. The loco-regional recurrence rate was 7% in the irradiated subgroups and 17% in the non-irradiated subgroups, the corresponding cure rates being 43% and 58%. Complete remission of all local recurrence was obtained after the first treatment in 67% of the cases, and was persistent in 67% of them (44% overall). Complete remission was obtained in all patients with local recurrence who received local treatment only, and was persistent in 65%. Of local recurrences treated with a combination of surgery, radiotherapy and hormone therapy, complete response was obtained in 94% of the patients, and was persistent in 94% of them (88% overall). Complete remission of all regional recurrence was obtained after the first treatment in 58% of the patients and was persistent in 67% of them (39% overall). Postoperative radiotherapy reduced not only the total number of loco-regional recurrences but also the number of uncontrolled loco-regional recurrences. Aggressive local treatment would appear to yield both satisfactory initial control and, when combined with the hormone therapy, a high rate of persistent loco-regional control.     

Expression and immunogenicity in rats of recombinant adenovirus 5 DNA plasmids and vaccinia virus containing the HTLV-I env gene

PURPOSE: To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachytherapy (HDRB) and external beam radiotherapy (EBRT) for patients found to have isolated vaginal recurrences from early-stage endometrial adenocarcinoma following total abdominal hysterectomy and bisalpingo-oophorectomy (TAH BSO). MATERIALS AND METHODS: Twenty patients originally diagnosed with early-stage endometrial adenocarcinoma (FIGO stage I or II) following TAH BSO developed isolated vaginal recurrences and were referred to our radiation oncology department for definitive treatment. The median time between TAH BSO and vaginal recurrence was 24 months. Thirteen patients received combined modality treatment (EBRT + HDRB) and seven patients received HDRB only. Median prescribed dose was 4400 cGy by EBRT and 2400 cGy to the vagina mucosa surface by HDRB in the combined modality group. Median prescribed dose was 3500 cGy to the vagina mucosa surface for the HDRB only group. These patients were followed for a median duration of 47.5 months following treatment for isolated vaginal recurrence. RESULTS: Eighteen of 20 patients (90%) achieved a complete response to therapy and the remaining 2 achieved a partial response. Four of 18 complete responders developed a second recurrence within 30 months following radiotherapy. Ten-year cumulative local control rate was 74%. Ten-year cumulative cause specific and disease-free survival rate was 71 and 46%. Overall late complication rate was 15%; there were no grade 3 or 4 late complications. Three patients developed grade 2 late complications from treatment; all 3 were from the combined modality group (HDRB + EBRT). CONCLUSION: The use of HDRB resulted in high complete response rates and durable long-term disease-specific survival in a substantial percentage of patients. To our knowledge, this study represents the first published results on treatment of vaginal recurrences with HDRB. Although the number of patients in this study is small, treatment results compare favorably to those obtained from patients treated with low-dose-rate brachytherapy +/- EBRT from other studies.     

Postoperative recurrent ulcer after gastric resection--results of surgical treatment]

Within a 10-year period, 50 patients with postoperative ulcer recurrence after gastric resection were treated; 31 of these had one, 8 two, 5 three and 6 four previous gastric operations. Ulcer recurrence was attributed to surgery-related causes in 78% of the cases; excessively large gastric remnant 56%, anastomotic stenosis 18%, loop problems 4%. Some 22% of the patients had causes independent of previous surgery: abuse of non-steroidal antirheumatics (NSAR) 10%, hyperacidity of normal gastric remnant 6%, Zollinger-Ellison-Syndrome 6%. The most important co-factor of ulcer genesis was chronic abuse of NSAR (38% of the total series). The interval between onset of complaints of ulcer disease and the last ulcer-dependent operation amounted on average to 13.8 (0.5-36) years. The definitive treatment of recurrent ulceration was surgery in 34 cases-indicated by ulcer complications (73.5%) or failure of medical therapy (26.5%)-and conservative treatment in 16 cases. Surgery comprised 21 re-resections, 7 thoracic truncal vagotomies 4 total gastrectomies 1 Whipple procedure and 1 enucleation of gastrinoma (hospital mortality 0%). During the follow-up period (median 7.1 years, follow-up rate 96%), the cumulative ulcer re-recurrence rate was 57% for the conservatively treated group and 17.6% for the patients treated by surgery (p < 0.05). In none of the eight patients who died during long-term follow-up was the cause of death ulcer-related.     

An alternative technique in the management of bullous emphysema. Thoracoscopic endoloop ligation of bullae

OBJECTIVE: This study was undertaken to evaluate the mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Retrospective review revealed 162 women with DCIS treated with breast-conserving therapy from 1978 to 1990 for whom follow-up data were available. Subsequent to therapy, 33 (20%) patients had a pathologically proven carcinoma in the treated breast. Mammograms at the time of local recurrence were available for 20 patients. We reviewed mammograms, clinical charts, and histopathologic findings in these 20 patients. For 14 of 20 patients, we also reviewed mammograms obtained at the time of the original DCIS. RESULTS: The median interval from diagnosis of the original DCIS to local recurrence was 26 months (range, 6-168 months). Recurrences were detected solely by mammography in 17 (85%) of 20 patients, by mammography and physical examination in two (10%), and solely by physical examination in one (5%). Eighteen (90%) local recurrence contained calcifications and eighteen (90%) involved the tumorectomy quadrant. When we compared available mammographic findings of the original DCIS and the local recurrence we found the mammographic pattern and calcification morphology to be the same in 11 (79%) of 14 DCIS and nine (82%) of 11 DCIS, respectively. Histopathologic analysis of recurrences found DCIS in 13 (65%) of 20 patients and DCIS and infiltrating carcinoma in the remaining seven (35%) patients. Of 13 pure DCIS recurrences, 12 (92%) were detected solely by mammography. CONCLUSION: In our study, local recurrence after breast-conserving therapy for DCIS invariably contained DCIS; 35% of recurrences also contained invasive carcinoma. The most common mammographic pattern of local recurrence was calcifications in the tumorectomy quadrant that were morphologically similar to the original DCIS. These findings suggest that many of these local recurrences reflect failure to eradicate the primary DCIS. Mammography achieved high sensitivity in revealing these lesions: 85% of local recurrences and 92% of recurrences that were pure DCIS were detected solely by mammography.     

Treatment of recurrent inguinal hernia by implantation of a pre-peritoneal prosthesis. Results of a prospective study

44 patients with 47 recurrent inguinal hernias entered a prospective study. All patients were operatively managed by a standardized technique using a polypropylene (Prolene) mesh inserted through a pre-peritoneal approach. Operating in the pre-peritoneal space avoids dissection of the scared cord and the "inlay" prosthetic mesh safely creates a new "fascia transversalis" with a low rate of recurrences. All patients were personally controlled every 6 months with a follow-up time of 12 to 60 months (mean 20.2 months). The low postoperative morbidity included only one seroma, no infection and no testicular complications. We observed one recurrence occurring 6 months after surgery (2%). The described operative technique using an inlay patch is recommended as the therapy of choice in all recurrent groin hernias.