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PubMed2004

Radio-guided surgery improves outcome of therapeutic excision in non-palpable invasive breast cancer.

Intratumoral injection of a radiocolloid for lymphatic mapping enables the therapeutic excision of clinically occult breast cancer with the aid of a gamma-ray detection probe. The aim of this study was to determine the success rate of radio-guided tumour excision in addition to a guide wire and to identify factors predicting clear margins. Sixty-five consecutive patients underwent radio-guided tumour excision after intratumoral injection of 99mTc-nanocolloid guided by ultrasound or stereotaxis. A localization wire was inserted after scintigraphy had been performed (group 1). The results were compared with retrospective data from 67 consecutive patients who underwent therapeutic wire-directed excision alone (group 2). Factors predicting clear margins (> or = 1 mm) were determined in a logistic regression model. Adequate margins were obtained in 83% of group 1 and in 64% of group 2 (P = 0.014). The invasive component was incompletely excised in two patients in group 1 and in 14 patients in group 2. Further surgery was performed in four patients in group 1 and in 14 patients in group 2. Factors predictive of clear margins were decreasing pathological tumour diameter (P = 0.035), increasing weight of the specimen (P = 0.046), absence of microcalcifications (P = 0.004) and absence of carcinoma in situ component (P = 0.024). Radio-guided excision was an independent predictor of complete excision of the invasive component (P = 0.012). The application of radio-guided surgery combined with wire localization seems to improve the outcome of therapeutic excision of non-palpable invasive breast cancer compared with wire-directed excision alone.

Breast Neoplasms↗

PubMed2002

Treatment of lateral ray polydactyly of the foot: focusing on the selection of the toe to be excised.

The purposes of this study were to evaluate the results of the operative treatment of lateral ray polydactyly and to consider appropriate surgical procedures, especially focusing on the selection of the toe, lateral toe or medial toe, to be resected. Twenty-two patients with lateral ray polydactyly foot (25 individual feet) at an average of 71 months' follow-up were included in this study. Cases were classified morphologically into three types on the basis of Hirase's configuration. In addition, these types were divided into two subtypes, metatarsal and phalangeal, on the basis of radiographic evaluation of the level of duplication. The clinical evaluations of the reconstructed toe were performed, and these results were investigated according to their morphologic classification and excised toe group. The distinctive problem of medial toe excision is valgus deformity. Eight of 25 toes retained persistent valgus deformity, and all of these cases were in the medial toe excision group. On the other hand, a distinctive problem in lateral toe excision is postoperative pain. Two patients suffered from postoperative pain in phalangeal type cases in the lateral toe excision group, and the remaining medial toe had a medial protuberant middle phalanx. The pain occurred at that protuberant point. Based on their experiences, the authors created an algorithm for selection of the toe to be excised. In metatarsal type cases, from a functional perspective, the toe that has a radiographically dominant metatarsus should be retained. On the other hand, in phalangeal type cases, the authors give priority to shape rather than function, and they excise the morphologically smaller toe independent of the condition of the phalanx as viewed on radiography. If the medial toe and the lateral toe are approximately the same size, the authors excise the lateral toe to avoid valgus deformity. When the lateral toe has severe valgus deformity that seems unlikely to be correctable intraoperatively, the lateral toe should be considered for excision even if it is larger than the medial toe.

Adolescent↗

PubMedDate not supplied

Factors associated with residual disease on re-excision in patients with ductal carcinoma in situ of the breast.

PURPOSE: This study examines the factors associated with the presence of residual disease at re-excision in patients with ductal carcinoma in situ of the breast. METHODS: Of 143 consecutive patients undergoing breast conservation treatment from 1990 to 1999, 90 patients (63%) underwent re-excision of the tumor bed. Grade was recorded in 70% (N = 63), size in 78% (N = 70), margin status in 96% (N = 86), volume of excision in 90% (N = 81), and extent of residual disease in 99% (N = 89). RESULTS: There was no significant correlation between extent of residual disease on re-excision and method of detection, tumor size, histology, grade, or first margin status. Of patients undergoing re-excision, 56% (N = 50) had no residual disease, 38% (N = 34) had minimal microscopic residual disease, and only 6% (N = 5) had either extensive microscopic or gross residual disease. For these five patients, the median volume of first excision was similar to that of the other patients (26 vs 36 cc), but the median volume of second excision was smaller (33 vs 63 cc). The median age for these five patients was 41 years, compared with 55 years for the remaining patients. All five patients had comedo (N = 4) or solid tumor (N = 1) histology, with grade 3 (N = 3) or unknown grade (N = 2). DISCUSSION: Patients with extensive microscopic disease or gross residual at the time of re-excision would be at increased risk for local recurrence after conventional radiation treatment if re-excision had not been performed. Only 6% of patients in this study had such pathology findings. No factor predicted for these adverse pathology findings, although these patients tended to be younger, with high-grade or comedo histology.

Adult↗

PubMed1995

Comparison of electric and growth responses to excision in cucumber and pea seedlings. II. Long-distance effects are caused by the release of xylem pressure.

Excision of a growing stem causes local wound responses, such as membrane depolarization and growth inhibition, as well as effects at larger distances from the cut. In this study, cucumber hypocotyls were excised 100 mm below the hook, so that the growing region was beyond the reach of the wound-induced depolarization (up to 40 mm). Even at such a distance, the cut still caused a considerable and rapid drop in the hypocotyl growth rate. This growth response is not a direct wound response because it does not result from the cut-induced depolarization and because it can be simulated by root pressure manipulation (using a pressure chamber). The results indicate that the growth response resulted from the rapid release of the xylem pressure upon excision. To test this conclusion we measured the xylem pressure by connecting a pressure probe to the cut surface of the stem. Xylem pressure (Px) was found to be +10 to +40 kPa in cucumber hypocotyls and -5 to -10 kPa or lower in pea epicotyls. Excision of the cucumber hypocotyl base led to a rapid drop in Px to negative values, whereas excision in pea led to a rapid rise in Px to ambient (zero) pressure. These fast and opposite Px changes parallel the excision-induced changes in growth rate (GR): a decrease in cucumber and a rise in pea. The sign of the endogenous xylem pressure also determined whether excision induced a propagating depolarization in the form of a slow wave potential (SWP). Under normal circumstances pea seedlings generated an SWP upon excision whereas cucumber seedlings failed to do so. When the Px in cucumber hypocotyls was experimentally inverted to negative values by incubating the cumber roots in solutions of NaCN or n-ethylmaleimide, excision caused a propagating depolarization (SWP). The experiment shows that only hydraulic signals in the form of positive Px steps are converted into propagating electric SWP signals. These propagating depolarizations might be causally linked to systemic 'wound' responses, which occur independently of the short-distance or direct wound responses.

Cucumis sativus↗

PubMed2005

Post-surgical assessment of excised tissue from patients with Buruli ulcer disease: progression of infection in macroscopically healthy tissue.

OBJECTIVE: The current standard of treatment of Buruli ulcer disease (BUD) is surgical excision of lesions. Excision size is determined macroscopically assuming the complete removal of all infected tissue. However, dissemination of infection beyond the excision margins into apparently healthy tissue, possibly associated with recurrences, cannot be excluded in this way. To assess the central to peripheral progression of Mycobacterium ulcerans infection and the mycobacterial infiltration of excision margins, excised tissue was examined for signs of infection. METHODS: 20 BUD lesions were excised in general anaesthesia including all necrotic and subcutaneous adipose tissue down to the fascia and at an average of 40 mm into the macroscopically unaffected tissue beyond the border of the lesion. Tissue samples were subjected to PCR and histopathology. RESULTS: Although the bacillary load decreased from central to peripheral, M. ulcerans infection was detected throughout all examined tissue specimens including the peripheral segments as well as excision margins of all patients. During the post-operative hospitalization period (averaging 2 months) no local recurrences were observed. CONCLUSION: Available data suggest a correlation of surgical techniques with local recurrences. The results of this study indicate the unnoticed early progression of mycobacterial infection into macroscopically healthy tissue. Thus, the removal of all infected tissue cannot always be verified visually by the surgeon. Provided that long-term follow up of patients with positive excision margins will establish the clinical relevance of these findings, on-site laboratory assessment of excised tissue in combination with follow up may contribute to reduce recurrence rates.

Adolescent↗

PubMed2006

Characteristics of basal cell carcinoma amongst Asians in Singapore and a comparison between completely and incompletely excised tumors.

BACKGROUND: Most published series of basal cell carcinomas (BCCs) are based on Caucasian populations. Very little is known about the characteristics of incompletely excised BCCs in Asians. OBJECTIVES: This study examines the characteristics of BCCs in Asian residents in Singapore, and compares incompletely with completely excised tumors after conventional surgical excision. PATIENTS AND METHODS: A retrospective study was conducted using the case records of patients who had a primary BCC excised at the National Skin Centre between 1991 and 1995. RESULTS: A total of 185 histologically confirmed BCCs were recorded in 166 patients (male to female ratio, 0.95; mean age, 70.9 years). The highest proportion (27.1%) was in the 81-90-year age group. Compared with census data, a significantly higher proportion of patients with BCCs were Chinese (P < 0.001). The tumors averaged 12.0 mm in diameter and the majority (84.3%) were located on the head and neck. In 28 lesions (15.1%), the tumors were incompletely excised, with those on the nose and nasolabial folds being most frequent. Incompletely excised BCCs were more likely than completely excised lesions to be located on the mid-face and trunk (P = 0.003), but there was no significant correlation with tumor size, tumor duration, or patient age, race, and gender. The overall recurrence rate was 1.6% over a mean follow-up time of 74 months. CONCLUSIONS: BCCs are more common amongst Chinese in Singapore and occur chiefly in the elderly. Conventional surgical excision with margin control achieves a satisfactory tumor clearance rate of 84.9%. Incomplete excision is associated with tumor location on the mid-face and trunk rather than tumor size or duration.

Adult↗

PubMed1972

Excision repair properties of isogenic rec mutants of Escherichia coli K-12.

We have examined the excision repair properties of isogenic rec(-) and uvr(-) strains of Escherichia coli K-12. A recB(-)recC(-) strain excises dimers at a rate nearly that of the rec(+) parent, reaching the same extent of excision after a 1-hr postirradiation incubation. recA(-) and recA(-)recB(-) strains excise 75 to 80% of the dimers excised by their rec(+) parent, whereas a uvrB(-) strain excises no dimers during a 1-hr incubation. The doses of ultraviolet light (254 nm) required to reduce survival to 37% of the original population are 8 ergs/mm(2) for recA or recA recB mutants, 5 ergs/mm(2) for the uvrB(-) strain, 30 ergs/mm(2) for the recB recC mutant, and 230 ergs/mm(2) for the wild-type parent. From these data one cannot account for the ultraviolet light sensitivity of rec(-) strains on the basis of their excision repair properties. We conclude that rec gene products play no significant role in the early steps of excision repair. The assay we have used for excision of thymine dimers is a modification of the Carrier-Setlow technique, and is described in detail in the Appendix to this paper. To show the properties and validity of this method, results of experiments with thymine dimers formed in vitro and in vivo in E. coli K-12 are presented. These results show our method to be reproducible and sensitive to 0.005% of the total radioactive thymine present in thymine-containing dimers.

Cell Survival↗

PubMed2000

Integration and excision of a Bacteroides conjugative transposon, CTnDOT.

Bacteroides conjugative transposons (CTns) are thought to transfer by first excising themselves from the chromosome to form a nonreplicating circle, which is then transferred by conjugation to a recipient. Earlier studies showed that transfer of most Bacteroides CTns is stimulated by tetracycline, but it was not known which step in transfer is regulated. We have cloned and sequenced both ends of the Bacteroides CTn, CTnDOT, and have used this information to examine excision and integration events. A segment of DNA that contains the joined ends of CTnDOT and an adjacent open reading frame (ORF), intDOT, was necessary and sufficient for integration into the Bacteroides chromosome. Integration of this miniature form of the CTn was not regulated by tetracycline. Excision of CTnDOT and formation of the circular intermediate were detected by PCR, using primers designed from the end sequences. Sequence analysis of the PCR products revealed that excision and integration involve a 5-bp coupling sequence-type mechanism possibly similar to that used by CTn Tn916, a CTn found originally in enterococci. PCR analysis also demonstrated that excision is a tetracycline-regulated step in transfer. The integrated minielement containing intDOT and the ends of CTnDOT did not excise, nor did a larger minielement that also contained an ORF located immediately downstream of intDOT designated orf2. Thus, excision involves other genes besides intDOT and orf2. Both intDOT and orf2 were disrupted by single-crossover insertions. Analysis of the disruption mutants showed that intDOT was essential for excision but orf2 was not. Despite its proximity to the integrase gene, orf2 appears not to be essential for excision.

Amino Acid Sequence↗

PubMed2003

Control of SXT integration and excision.

The Vibrio cholerae SXT element is a conjugative self-transmissible chromosomally integrating element that encodes resistance to multiple antibiotics. SXT integrates in a site-specific fashion at prfC and excises from the chromosome to form a circular but nonreplicative extrachromosomal form. Both chromosomal integration and excision depend on an SXT-encoded recombinase, Int. Here we found that Int is necessary and sufficient for SXT integration and that int expression in recipient cells requires the SXT activators SetC and SetD. Although no xis-like gene was annotated in the SXT genome, Int was not sufficient to mediate efficient SXT chromosomal excision. We identified a novel SXT Xis that seems to function as a recombination directionality factor (RDF), facilitating SXT excision and inhibiting SXT integration. Although unrelated to any previously characterized RDF, Xis is similar to five hypothetical proteins that together may constitute a new family of RDFs. Using real-time quantitative PCR assays to study SXT excision from the chromosome, we determined that while SXT excision is required for SXT transfer, the percentage of cells containing an excised circular SXT does not appear to be a major factor limiting SXT transfer; i.e., we found that most cells harboring an excised circular SXT molecule do not act as SXT donors. In the absence of prfC, SXT integrated into several secondary attachment sites but preferentially into the 5' end of pntB. SXT excision and transfer from a donor containing pntB::SXT were reduced, suggesting that the SXT integration site may also influence the element's transmissibility.

Amino Acid Sequence↗

PubMed2002

The M184V mutation reduces the selective excision of zidovudine 5'-monophosphate (AZTMP) by the reverse transcriptase of human immunodeficiency virus type 1.

The M184V mutation in human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) causes resistance to lamivudine, but it also increases the sensitivity of the virus to zidovudine (3'-azido-3'-deoxythymidine; AZT). This sensitization to AZT is seen both in the presence and the absence of the mutations that confer resistance to AZT. AZT resistance is due to enhanced excision of AZT 5'-monophosphate (AZTMP) from the end of the primer by the RT of the resistant virus. Published data suggest that the excision reaction involves pyrophosphorolysis but that the likely in vivo pyrophosphate donor is not pyrophosphate but ATP. The mutations that lead to AZT resistance enhance ATP binding and, in so doing, enhance pyrophosphorolysis. The excision reaction is specific for AZT because HIV-1 RT, which can form a closed complex with a dideoxy-terminated primer and an incoming deoxynucleoside triphosphate (dNTP), does not form the closed complex with an AZTMP-terminated primer and an incoming dNTP. This means that an AZTMP-terminated primer has better access to the site where it can be excised. The M184V mutation alters the polymerase active site in a fashion that specifically interferes with ATP-mediated excision of AZTMP from the end of the primer strand. The M184V mutation does not affect the incorporation of AZT 5'-triphosphate (AZTTP), either in the presence or the absence of mutations that enhance AZTMP excision. However, in the presence of ATP, the M184V mutation does decrease the ability of HIV-1 RT to carry out AZTMP excision. Based on these results, and on the results of other excision experiments, we present a model to explain how the M184V mutation affects AZTMP excision.

Adenosine Triphosphate↗

PubMed1986

Somatic excision of transposable element Tc1 from the Bristol genome of Caenorhabditis elegans.

We investigated the ability of the transposable element Tc1 to excise from the genome of the nematode Caenorhabditis elegans var. Bristol N2. Our results show that in the standard lab strain (Bristol), Tc1 excision occurred at a high frequency, comparable to that seen in the closely related Bergerac strain BO. We examined excision in the following way. We used a unique sequence flanking probe (pCeh29) to investigate the excision of Tc1s situated in the same location in both strains. Evidence of high-frequency excision from the genomes of both strains was observed. The Tc1s used in the first approach, although present in the same location in both genomes, were not known to be identical. Thus, a second approach was taken, which involved the genetic manipulation of a BO variant, Tc1(Hin). The ability of this BO Tc1(Hin) to excise was retained after its introduction into the N2 genome. Thus, we conclude that excision of Tc1 from the Bristol genome occurs at a high frequency and is comparable to that of Tc1 excision from the Bergerac genome. We showed that many Tc1 elements in N2 were apparently functionally intact and were capable of somatic excision. Even so, N2 Tc1s were prevented from exhibiting the high level of heritable transposition displayed by BO elements. We suggest that Bristol Tc1 elements have the ability to transpose but that transposition is heavily repressed in the gonadal tissue.

Animals↗

PubMedDate not supplied

Cold knife conization and loop excision for cervical intraepithelial neoplasia.

AIMS AND BACKGROUND: Our aim was to investigate whether loop excision is an acceptable alternative to traditional cold knife conization of the cervix. PATIENTS AND METHODS: 240 with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 120) or cold knife conization (n = 120). Success and complication rates of both methods were analysed. RESULTS: 100% of cold knife conization and 98% of loop excision surgical specimens were positive for dysplasia. The rate of complete resection was 91% in the cold knife and 82% in the loop excision group, but histologic confirmation of residual CIN was obtained in only 2 (1.7%) women after cold knife conization and in 5 (4.2%) after loop excision. Loop excision cones were significantly shallower than those obtained by a cold knife. Secondary surgical procedures due to early hemorrhage were performed in 9 (7.5%) patients treated with cold knife conization and in 8 (6.7%) treated with loop excision. Elevated temperature postoperatively was observed in 16.4% of patients after cold knife conization and in 13.9% after loop excision. There were no other postoperative complications. CONCLUSIONS: The results suggest that cold knife conization and loop excision are comparable and equally effective diagnostic and therapeutic procedures for CIN.

Adult↗

PubMed2004

Fractures of the radial head and neck treated with radial head excision.

BACKGROUND: The reported long-term outcomes of the treatment of radial head and neck fractures with excision of the radial head have been mixed. The purpose of the present study was to evaluate the long-term outcomes of primary or delayed radial head excision for the treatment of these fractures. METHODS: Sixty-one individuals (mean age, forty-four years) with thirty-nine Mason type-II, ten Mason type-III, and twelve Mason type-IV fractures were evaluated subjectively, objectively, and radiographically at a mean of eighteen years (range, eleven to thirty-three years) after treatment. Forty-three fractures were treated with primary radial head excision, and the remaining eighteen were treated with delayed radial head excision at a median of five months (range, one to 238 months) after the injury. RESULTS: At the time of follow-up, twenty-eight individuals had no symptoms, twenty-seven had occasional elbow pain, and six had daily pain. Four individuals with daily pain had had a Mason type-IV fracture. The range of motion of the formerly injured upper extremities was slightly less than that of the uninjured upper extremities in terms of flexion (139 degrees +/- 11 degrees compared with 142 degrees +/- 8 degrees ), extension (-7 degrees +/- 12 degrees compared with -1 degrees +/- 6 degrees ), and supination (77 degrees +/- 20 degrees compared with 85 degrees +/- 10 degrees ) (all p < 0.01). A higher percentage of formerly injured elbows than uninjured elbows had cysts, sclerosis, and osteophytes (73% compared with 7%; p < 0.001), but none had a reduced joint space. No differences were found between the outcomes for individuals treated with a primary radial head excision and those for individuals treated with a delayed excision. CONCLUSIONS: Following a displaced radial head or neck fracture, excision of the radial head often leads to a good or fair result. We found no differences in outcome between primary and delayed radial head excisions following a Mason type-II, III, or IV fracture. The outcomes are associated with the type of fracture, with Mason type-IV fractures having the worst results, rather than with the timing of the radial head excision (primary or delayed).

Adolescent↗

PubMed2000

Efficacy of curettage before excision in clearing surgical margins of nonmelanoma skin cancer.

OBJECTIVE: To determine whether curettage before excision of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) improves margin clearance rates. DESIGN: A retrospective, nonrandomized, case-control series of nonmelanoma skin cancers treated with preexcisional curettage followed by simple excision was identified using a computerized search of the database of a dermatopathology service. A validation cohort was established by manually identifying nonmelanoma skin cancers treated with wide excision on a given day. SETTING: All analyzed specimens were derived from the Dermatopathology Service at the University of California, San Francisco, a university-based laboratory that provides interpretation of skin biopsy specimens received directly from community (90%) and academic (10%) practices. PATIENTS: Our retrospective cohort consisted of all nonrecurrent nonmelanoma skin cancers diagnosed by biopsy and treated by simple excision between April 1, 1997, and April 30, 1999. There were 1983 BCCs and 849 SCCs included in our study. The validation cohort included skin cancers diagnosed by biopsy treated with simple excision on the 16th day of each month during the same period. INTERVENTION: Preexcisional curettage. MAIN OUTCOME MEASURE: We compared the frequency of tumor margin involvement of curetted vs noncuretted lesions. Margin involvement was considered surgical failure. RESULTS: Forty-two pecent of BCCs and 34% of SCCs were curetted before excision. In BCC, risks for surgical failure included head and neck lesions (P<.001), lesions treated by physicians performing fewer than 51 procedures (P<.001), and invasive subtypes (P<.01). Factors associated with surgical failure in SCC included in situ disease (P=.01) and an older (77 vs 74 years) patient population (P=.05). In univariate analysis, curettage before excision decreased the surgical failure rate for BCC by 24% (P=.03) but did not decrease the rate for SCC (P=.8). In multivariate analysis, curettage of BCC reduced surgical failure rates by 26% when the physician performed 50 skin cancer excisions or less during the study (odds ratio, 0.74; 95% confidence interval, 0.57-0.95;P=.02). CONCLUSION: Preoperative curettage decreases the frequency of positive margins in the management of BCC but not of SCC.

Adult↗

PubMed2004

Management of lentigo maligna and lentigo maligna melanoma with staged excision: a 5-year follow-up.

OBJECTIVE: To assess the long-term cure rate for treatment of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by means of a staged, margin-controlled, vertical-edged excision with rush permanent specimens and a radial sectioning technique. DESIGN: Retrospective follow-up study. SETTING: University-affiliated and private-practice dermatologic surgery clinics. PATIENTS: Fifty-nine patients treated for 55 LMs and 7 LMMs between January 1, 1990, and December 31, 2001. INTERVENTIONS: The technique included vertical excision with initial 2- to 3-mm margins examined by rush permanent sections (prepared and read within 24 hours). Further excision took place as guided by histologic findings. Data on patient and lesion characteristics were obtained via a medical chart review. Patients were then contacted and examined for local recurrence. Biopsies were performed on all patients with possible recurrence on clinical examination. MAIN OUTCOME MEASURES: Local recurrence of LM or LMM. RESULTS: After a mean follow-up of 57 months (median, 54 months; 293.8 person-years), 95% of patients were free of recurrence. Three patients had local recurrence and no patients had evidence of metastasis. Two of the 3 local recurrences were of previously excised LM, and 1 was of an LMM. Half (32) of all lesions required 2 or more stages. One required more than 4 stages. The average margin of excision was 0.55 cm. Three of the 58 lesions read as LM on biopsy were found to have invasive disease (LMM) at the time of definitive excision. CONCLUSIONS: The technique described herein for the treatment of LM and LMM provides a long-term disease-free survival of 95%. The cure rate is greater than that reported for standard excision and is similar to that for other margin-control techniques. To our knowledge, this is the largest reported study and has the longest follow-up for this excision method for LM and LMM.

Adult↗

PubMed2003

Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary?

BACKGROUND: Radial scars are benign lesions that may mimic breast carcinoma on mammography and usually are managed by excision biopsy. The authors report their experience with stereotactic needle core biopsy (SNCB) in sampling these lesions. METHODS: A prospective study examined a consecutive series of 75 mammographically detected radial scars from a population-based screening program. In patients who were sampled by SNCB followed by surgical biopsy, the histologic findings of core biopsy and the gold standard of excision biopsy were compared. RESULTS: Sixty-three patients were sampled by core biopsy: SNCB was used in 55 patients (87.0%), and ultrasound-guided needle core biopsy (UNCB) was used in 8 patients (13%). One patient who underwent SNCB did not undergo a follow-up excision biopsy. Radial scars were diagnosed preoperatively by core biopsy in 51 of 62 patients who underwent excision (82%; 95% confidence interval [95%CI], 70-91%). The sensitivity for SNCB was 85% (95%CI, 73-94%), and the sensitivity for UNCB was 63% (95%CI, 24-91%). Of 54 patients who underwent SNCB and excision, 4 patients had coexistent ductal carcinoma in situ (DCIS) at the time they underwent surgical excision: SNCB identified DCIS in 1 patient and identified atypical ductal hyperplasia (ADH) in 3 patients. In the entire group of 75 radial scars, 5 scars were associated with DCIS (7%), and there were no invasive carcinomas. ADH was present in association with 42 of 74 radial scars that were excised surgically (57%). Twenty-nine of those radial scars were sampled preoperatively by SNCB. ADH was found in 21 patients (72%; 95CI, 53-87%). CONCLUSIONS: The sensitivity of SNCB in the identification of radial scars was 85%. In four patients with associated DCIS, SNCB revealed either ADH or DCIS, both of which required excision. These findings suggest that patients with SNCB-proven radial scars among a screened population can be managed safely by mammographic follow-up, provided there is no associated DCIS, ADH, or lobular carcinoma in situ. Spiculated abnormalities with discordant SNCB results require surgical biopsy.

Adult↗

PubMed1990

Excision of transposon Tn917 in Bacillus subtilis.

Excision of Tn917 from chromosomal sites in B. subtilis is characterized by reversion studies. We propose different modes of excision depending on the site of transposon insertion. Excision takes place as precise excision in one step which results in reversion of the mutant phenotype, or by a two-step process where nearly precise excision of the transposon moiety is followed by precise excision of the nearly precise excision remnants. For this type of transposons a minor pathway or nonreplicative transposition is proposed to be connected with precise excision.

Bacillus subtilis↗

PubMed1999

Evaluation of CO(2) laser excision or vaporization for the treatment of vulvar intraepithelial neoplasia.

OBJECTIVE: Our objective was to evaluate the results of laser surgery in patients with vulvar intraepithelial neoplasia (VIN). METHODS: From January 1990 to December 1996, 52 patients with histologically proven VIN were treated with CO(2) laser vaporization or laser excision. The analysis included anamnestic characteristics, clinical aspects, types of treatment, correlation of the preoperative biopsy with the excised pathologic specimen, and follow-up results. RESULTS: Fourteen women underwent laser vaporization, and 38, laser excision. Of the patients submitted to vaporization, 11 were cured in one session (75%), 1 required two procedures, and 2 other patients, who underwent more treatments, eventually developed invasive squamous cell cancer 5 and 7 years from the initial treatment. The cure rate for laser excision was better, as a single session of treatment was curative in 33 of 38 patients (87%). In 3 cases the pathology report on the excised specimen showed an unrecognized invasive lesion (12%) and the women underwent radical surgery. The 2 remaining patients, both affected by multifocal disease, experienced recurrences and were treated with laser excision 2 and 3 years after the primary treatment, respectively. Symptom relief was obtained in all patients studied with both laser vaporization and excision. CONCLUSIONS: Excisional laser surgery is an effective treatment for patients with VIN. In addition, CO(2) laser excision allows evaluation of the operative specimen and detection of occult early invasion with good preservation of vulvar morphology; laser vaporization, while retaining good cosmetic results, is less effective in VIN treatment and does not allow evaluation of the surgical specimen.

Adult↗