Biomedical subjects

Christopher M Pezzi

Publications and source records attributed to Christopher M Pezzi.

7 recordsLinked to original sources

PubMed2006

Characteristics and treatment of metaplastic breast cancer: analysis of 892 cases from the National Cancer Data Base.

BACKGROUND: Metaplastic breast cancer (MBC) is characterized by various combinations of adenocarcinoma, mesenchymal, and other epithelial components. It was officially recognized as a distinct pathologic diagnosis in 2000. With few published reports, we hypothesized that MBC may have markedly different characteristics at presentation than typical infiltrating ductal carcinoma (IDC) and may be managed differently. METHODS: Data from patients with MBC and IDC reported to the National Cancer Database from January 2001 through December 2003 were reviewed for year of diagnosis, patient age, race/ethnicity, tumor size, nodal status, American Joint Committee on Cancer (AJCC) stage, tumor grade, hormone receptor status, and initial treatment, and were analyzed statistically by the Pearson chi(2) test. RESULTS: A total of 892 patients with MBC and 255,164 patients with IDC were identified. The group with MBC was older (mean age, 61.1 vs. 59.7 years; P = .001), had a significantly increased proportion of African American (14.1%, 126 of 892, vs. 10.2%, 25,900 of 255,164; odds ratio [OR], 1.455, P = .001) and Hispanic patients (5.5%, 49 of 892 vs. 3.9%, 9,947 of 255,164; OR, 1.817, P = .001), had fewer T1 tumors (29.5% vs. 65.2%), more N0 tumors (78.1% vs. 65.7%, OR, .5, P = .001), more poorly or undifferentiated tumors (67.8% vs. 38.8%), and fewer estrogen receptor-positive tumors (11.3% vs. 74.1%, OR, 22.4, P = .001) than the IDC group. Patients with MBC were treated with breast-conserving surgery less frequently than patients with IDC (38.5% vs. 55.8%, OR, 2.0, P = .001) because of the larger tumor size. Chemotherapy was used more often for patients with MBC (53.4% vs. 42.1%, OR, 1.6, P = .001) because of more advanced AJCC stage. CONCLUSIONS: MBC is a rare tumor with different characteristics than IDC: it presents with larger tumor size, less nodal involvement, higher tumor grade, and hormone receptor negativity. Patients with MBC are treated more aggressively than IDC (more often with mastectomy and chemotherapy) because of a higher stage at presentation, but are being treated by the same principles as IDC. Follow-up will determine the long-term results of the current treatment.

Breast Neoplasms↗

PubMed2006

Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (LigaSure) versus conventional clamp-and-tie technique.

Operative time in thyroid surgery can be safely reduced through use of a new bipolar electrosealing device (LigaSure). We evaluated consecutive patients undergoing thyroid surgery from January 2003 through January 2005 (n=155). During the first half of the study, hemostasis was obtained using silk ties (conventional group, n=70). During the second half of the study period, hemostasis was obtained with a bipolar electrosealing device (LigaSure group, n=85). The mean operative time was 130 +/- 37 minutes in the conventional group and 110 +/- 33 minutes (P < 0.001) in the LigaSure group. EBL in the LigaSure group was statistically significantly less (43 +/- 53 vs 33 +/- 33 mL; P < 0.05). Postoperative calcium level was statistically significantly higher in the LigaSure group (8.2 +/- 0.5 vs 8.4 +/- 0.6 mg/dL, P < 0.05). Hospital length of stay (LOS) did not differ significantly. One patient in each group developed neck hematoma requiring reoperation. One permanent recurrent nerve injury occurred in the conventional group and one transient bilateral recurrent nerve injury occurred in the LigaSure group. The occurrence of symptomatic hypocalcemia was similar between the two groups. The training level of the surgical resident had no significant impact on the operative time, estimated blood loss (EBL), LOS, or complication rate. LigaSure bipolar electrosealer as the primary means of hemostasis during thyroidectomy significantly reduces mean operative times. Rates of operative complications were unchanged. LigaSure use in thyroid surgery can safely increase efficiency.

Analysis of Variance↗

PubMed2005

Has the 80-hour work week had an impact on voluntary attrition in general surgery residency programs?

BACKGROUND: This article attempts to assess the effect of the duty-hour limitations implemented in 2003 on voluntary withdrawal of general surgery residents. STUDY DESIGN: A questionnaire asked the program directors how many categorical general surgery residents left voluntarily in 2003 to 2004, their training levels, why they left, and where they went. Results were compared with an identical study of 2000 to 2001 and analyzed statistically using chi-square analysis. RESULTS: A total of 215 programs (85%) responded, compared with 206 programs (81%) in the previous study. One hundred two programs (48%) reported voluntary attrition of 148 residents, compared with 110 programs (53%) and 167 residents previously. An average of 1.5 residents per program left in programs that reported attrition and 0.7 residents per program in all responders, compared with 1.5 and 0.8 residents in the previous study. In both studies, most programs with attrition lost one (66% [2000 to 2001] and 65% [2003 to 2004]) or two residents (21% [2000 to 2001] and 27% [2003 to 2004]). Most attrition occurred at PGY1 (47%) and PGY2 (28%) levels; a total of 75% of all attrition occurred at these levels, compared with a total of 76% in the previous study. One hundred eleven residents (75%) entered other medical specialties, and 23 (16%) transferred to other general surgery programs, compared with 105 residents (63%) and 40 residents (24%) in the previous study. In both studies, personal issues and work hours/lifestyle were cited as the most common reasons for leaving. In each study, the net loss to general surgery (the number of residents who left voluntarily divided by the total resident population at risk) was 3% for that academic year. Analysis showed no statistically significant difference. CONCLUSIONS: Rates and patterns of attrition seem to have been unaffected by Accreditation Council for Graduate Medical Education work-hours limitations.

Adult↗

PubMed2004

Breast conservation surgery using nipple-areolar resection for central breast cancers.

HYPOTHESIS: Resection of the nipple-areolar complex (NAC) for central breast cancers that involve the nipple or areola, with postoperative radiation therapy, adheres to the oncologic principles established for breast conservation surgery of other breast cancers. Good or excellent cosmetic results can be achieved. The rate of ipsilateral breast recurrence will be similar to that seen with peripheral breast cancers. The indications for breast conservation surgery can be safely extended to include patients with breast cancers that involve the NAC. DESIGN: Retrospective medical record review; follow-up patient questionnaire. SETTING: Community teaching hospital. PATIENTS: Fifteen patients, aged 46 to 88 years, whose central breast cancers involved the NAC precluding preservation of the NAC. INTERVENTIONS: Nipple-areolar complex resection, postoperative radiation therapy. MAIN OUTCOME MEASURES: Ipsilateral breast recurrence, survival, cosmesis. RESULTS: Ten patients had subareolar cancers that directly involved the nipple or areola; 5 patients had Paget disease of the nipple. Average tumor size was 1.6 cm (range, 0.2-3.5 cm). With a mean follow-up of 32 months (range, 4-109 months), there has been only 1 recurrence (7%), which was treated successfully by modified radical mastectomy. All 15 patients are alive and free of disease. Cosmetic results are satisfactory to excellent, as judged by both the patients and the surgeons. CONCLUSIONS: Nipple-areolar complex resection for central subareolar cancers that directly involve the NAC, as well as for Paget disease of the nipple, extends the indications for breast conservation in other areas of the breast, and with acceptable cosmesis.

Aged↗

PubMed2003

Leiomyosarcoma of the major peripheral arteries: case report and review of the literature.

We describe a case of primary intramural, extraluminal leiomyosarcoma of the common iliac artery. The patient presented with pelvic and leg pain and pheochromocytoma-like symptoms. The diagnosis was made intraoperatively, the tumor was resected, vascular reconstruction was performed, and postoperative radiation therapy was administered. Primary leiomyosarcoma of a major peripheral artery is extremely rare, and this report examines the clinical presentation, treatment, and prognosis of these patients.

Adult↗

PubMedDate not supplied

Intraabdominal pulmonary sequestration.

Bronchopulmonary sequestration is an uncommon developmental abnormality that frequently presents as an incidental mass. Differential diagnosis includes malignancy. Reports of extralobar abdominal pulmonary sequestration in adults are sparse. Only 2.5% of all pulmonary sequestrations are detected below the diaphragm. The authors present a case of a 45-year-old woman and a literature review. Computed tomography, magnetic resonance imaging, and operative and pathologic findings are provided. A review of diagnosis and therapy is presented.

Abdomen↗

PubMedDate not supplied

Incidentalomas of the parathyroid gland: multiple presentations, variable function, and review of the literature.

OBJECTIVE: To present a series of cases of parathyroid incidentalomas and review the related medical literature. METHODS: The medical records of all patients of one surgeon who underwent unplanned removal of enlarged parathyroid glands found either during a surgical procedure performed for indications other than hyperparathyroidism or by ultrasonography of the thyroid gland between September 1989 and December 2003 were reviewed retrospectively. Clinical and laboratory data-- especially serum calcium and parathyroid hormone (PTH) levels--as well as information on postoperative parathyroid function are reported. RESULTS: Among 421 patients (355 who underwent thyroidectomy and 66 who underwent transhiatal esophagectomy), 5 cases of parathyroid incidentalomas (1.2%) were identified. These incidental parathyroid adenomas were found during thyroidectomy for thyroid cancer in two patients, during esophagectomy for esophageal cancer in one patient (the first such reported case), and during ultrasonography of the neck for evaluation of thyroid nodules in two patients. Of the five patients, three had a normal and one had a slightly increased serum calcium concentration preoperatively; the serum calcium level was not determined preoperatively in the other patient. In one patient in whom intraoperative PTH level was determined both before and after resection of a large parathyroid adenoma, the initially high PTH value (180 pg/mL) declined to the normal range (48.2 pg/mL). In another patient, bone densitometry 9 months postoperatively showed an 8% increase in T-score for the lumbar spine and a 3.9% increase in T-score at the femoral neck, in comparison with bone density tests done 3 months preoperatively. No patient had persistent or recurrent hyperparathyroidism or hypoparathyroidism postoperatively or during subsequent follow-up. CONCLUSION: Incidental identification of enlarged parathyroid glands during a neck surgical procedure is not common but does occur. Intraoperative and postoperative measurements of serum calcium and PTH along with postoperative bone density testing can help determine whether such parathyroid incidentalomas are functional. These enlarged parathyroid glands should be removed.

Adenoma↗