Open Access Opinion Article

The Current Robotic da Vinci System has Limitations for Colorectal Surgical Procedures

ALAsari Sami

Journal of Advances in Medicine and Medical Research, Page 2768-2770
DOI: 10.9734/BJMMR/2014/8357

Since the introduction of the robotic da Vinci Surgical System, several advantages have been demonstrated in all surgical specialties, particularly in pelvic surgery. However, the current system still has several limitations; one is technically related. In this article, we give our opinion on this limitation and present our recommendations for improvement of robotic surgery in relation to colorectal surgery.

Open Access Minireview Article

Involvement of Reactive Oxygen Species in Hypertension: Its Roles, Production and Therapeutic Strategies

Hongzhuan Yin, Long Liao, Jun Fang

Journal of Advances in Medicine and Medical Research, Page 2771-2782
DOI: 10.9734/BJMMR/2014/8536

Hypertension is a major risk factor to human health. Many factors are known to involved in the pathogenesis and progression of hypertension, among which overproduction of reactive oxygen species (ROS) is closely associated with it in part by impairing endothelial function. In our laboratory, we found that ROS exert an important biological effect on the regulation of normal physiological responses of the cardiovascular system and the pathogenesis of hypertension. Namely, superoxide and hydrogen peroxide are over-produced under various pathological states which subsequently reduce the bioavailability of endothelium-derived nitric oxide, the vital molecule to maintain vasorelaxation. Understanding the roles of ROS in hypertension is thus important to develop new therapeutic strategies for the control of hypertension. The present review addresses the putative function of ROS in the pathogenesis of hypertension and focuses on the therapeutical potentials of the inhibitors of Xanthine oxidase that is a main source of ROS in diseased inflammatory conditions including hypertension.

Open Access Original Research Article

Correlation of Clinical and Pathological Parameters with the Diversity and Genetic Evolution of Breast Cancer in Senegalese Women

F. Mbaye, A. Dem, M. Fall, E. S. Mbaye, G. Diop, R. Ndiaye, M. S. Niang, A. Dieye, M. Sembene

Journal of Advances in Medicine and Medical Research, Page 2627-2638
DOI: 10.9734/BJMMR/2014/6859

Aims: The purpose of this study was to assess the hypothesis that genetic diversity of breast cancer is related to clinical and pathological tumors characteristics.
Study Design: Representative sequences of mitochondrial Cytochrome b gene of cancerous tissues were analyzed to determinate diversity and genetic evolution of breast tumors in Senegalese women.
Place and Duration of Study: Department of biology Animal (University Cheikh Anta Diop), laboratory of molecular biology (IRD-CBGP), 2011-2013.
Methodology: Genetic diversity of breast tumors in 57 Senegalese patients was estimated by analyzing sequences of the Cytochrome b mitochondrial coding gene. The Cytochrome b sequences from cancerous tissues were aligned using BioEdit version 7.0.8. Number of polymorphic sites, parsimony informative sites, the rate of transitions/transversions and the nucleotide frequency were calculated using MEGA 5.05. Genetic distance (d) was calculated with MEGA 5 using the Kimura 2-parameter (K2P) model. The index of genetic differentiation (Fst) used to describe the distribution of the genetic diversity between sub-groups was calculated with the software DnaSP version 10.5.01. The significance level (P-value) was 0.05.
Results: Analyses have revealed a high score of haplotype (Hd=0.991+/-0.008) and nucleotide diversity (Pi=0.15650+/-0.01326). Statistical correlations have shown a positive association between the risk factors (age of the patients, appearance of the first menstruation beyond 12 years, number of gestation) and nucleotide diversity of tumors (P<0.0001). Statistical analyses based on t-test showed a positive association between age, date of onset of the first menstruation and nucleotide diversity (Pi), between healthy and cancerous tissues for each patient (P<0.0001).
Conclusion: Our results have shown an important genetic diversity in breast tumors. A strong genetic differentiation was noted depending on the number of gestations.

Open Access Original Research Article

Correlation of MRI Findings of Intervertebral Disc Water Content and Disc Height with Self-rated Quality of Life, Pain and Disability

B. C. Bertilson, A. Claesson, C. Claesson, E. Sjövald

Journal of Advances in Medicine and Medical Research, Page 2639-2652
DOI: 10.9734/BJMMR/2014/7345

Aims: To investigate (1) the correlation between MRI findings of Intervertebral disc water content and disc height, with self-rated quality of life (QoL), pain, and disability respectively, and (2) the correlation between QoL and pain, and QoL and disability respectively.
Study Design: Clinical diagnostic study.
Place and Duration of Study: Ersta hospital radiological department, Stockholm, between February and september 2004.
Methodology: Eighty-eight patients referred for MRI of the spine due to suspect spine-related discomfort and with no previous surgery of the affected spinal region, were included. In conjunction with the MRI examination, the patients filled out questionnaires to assess QoL, pain and disability. QoL was assessed with Euro-QoL-5D (EQ), pain was self-assessed with a Visual Analogue Scale (VAS), neck-related disability with Neck Disability Index (NDI), and low back-related disability with Oswestry Disability Index (ODI).
Results: Correlations between disc water content and EQ, VAS, NDI and ODI were - 0.09,0.13, -0.23 and 0.18, respectively. Correlations between disc height and EQ, VAS, NDI and ODI were 0.05, -0.11, -0.23 and -0.05, respectively. Correlation between EQ and VAS was -0.17, correlation between EQ and NDI was -0.5, and correlation between EQ and ODI was -0.49.
Conclusion: No correlation was found between MRI findings of reduced Intervertebral disc water content and disc height with QoL, pain and disability. Other variables may be sought to explain self-rated QoL, pain, and disability among patients referred to MRI of the spine. In our study, the correlation between QoL and pain was not significant. However, the correlation between QoL and disability was significant, indicating that disability may have a greater impact on self-perceived QoL than pain.

Open Access Original Research Article

Activity of Lecithin Cholesterol Acyl Transferase and Apolipoprotein A-I in Newly Detected Type 2 Diabetes mellitus

Suman Doddamani, Shashikant Nikam, Padmaja Nikam, Archana Dambal

Journal of Advances in Medicine and Medical Research, Page 2653-2660
DOI: 10.9734/BJMMR/2014/5551

Aims: 1. To study the levels of Apolipoprotein A-I and activity of Lecithin cholesterol acyl transferase (LCAT) in newly detected type 2 Diabetes Mellitus.
Study Design: Cross sectional study.
Place and Duration of Study: Department of Biochemistry and Department of Medicine, Belgaum Institute of Medical Sciences (BIMS), Belgaum, Karnataka, India, between November 2011 and June 2013.
Methods: Study included 100 patients (50 men, 50 women, age range 30-60 years) with newly detected type 2 Diabetes Mellitus and 100 age and sex matched healthy participants. LCAT activity was assessed by measuring the difference between esterified and free cholesterol. Determination of free and esterified cholesterol was done by using digitonin precipitation method. Apolipoprotein A-I was measured by immunoturbidemetric method using semi auto analyzer. HDL cholesterol level was measured by CHOD-POD method.
Results: The mean±SD value of various parameters in newly detected type 2 Diabetes Mellitus was HDL cholesterol(33.37±4.44mg/dl), Apolipoprotein A-I(133.10±24.22mg/dl), and LCAT activity(59±9.86 IU/L), versus HDL cholesterol(48.76±16.84mg/dl), Apolipoprotein A-I(188.72±19.49mg/dl) and LCAT activity (91.74±6.50IU/L) in controls. LCAT activity, Apolipoprotein A-I and HDL levels were significantly (p < 0.01) decreased in patients with newly detected type 2 Diabetes Mellitus when compared with healthy participants.
Conclusion: The reduced LCAT activity, Apolipoprotein-A-I and HDL cholesterol may be associated with a reduction in Reverse cholesterol transport(RCT) and contribute to the development of atherosclerosis in newly detected type 2 Diabetes Mellitus.

Open Access Original Research Article

A Novel High-strength GIC System Composed of Poly (Acrylic Acid) With Different Molecular Architectures

Dong Xie, Jun Zhao, Yiming Weng, Jun Sun

Journal of Advances in Medicine and Medical Research, Page 2661-2683
DOI: 10.9734/BJMMR/2014/8760

Aims: The objective of this study was to synthesize and characterize the poly (acrylic acid) or PAA with different molecular architectures, use these polymers to formulate the cements with glass fillers, and evaluate the mechanical strengths of the formed cements.
Materials and Methods: The novel poly (acrylic acid)s with different molecular architectures were synthesized via ATRP technique. The reaction kinetics was studied. The formed cements were evaluated using compression, diametral compression, and 3-point bending, fracture toughness, knoop hardness, and wear resistance tests. The experimental cement was also evaluated for its in vitro biocompatibility.
Results: The results showed that either hyperbranched or star-hyperbranched polymer synthesis proceeds more slowly at the early stage but accelerates more quickly at the later stage than the star-shaped polymer synthesis. The higher the arm number and initiator concentration, the faster the ATRP reaction. It was also found that the higher the arm number and branching that the polymer had, the lower the viscosity of the polymer aqueous solution and the lower the mechanical strengths of the formed cement exhibited. The mechanical strengths of all three experimental glass-ionomer cements were very similar to each other but much higher than those of Fuji II LC. The aging study showed that all the experimental cements increased their CS continuously during 30 days, unlike Fuji II LC. This novel cement system was proven to be in vitro biocompatible because it showed no any noticeable cytotoxicity to human dental pulp cells and mouse 3T3 mouse fibroblasts.

Open Access Original Research Article

Association of BRCA1/2 Mutation and TP53 Over-Expression with Sporadic vs. Hereditary Iraqi Ovarian Cancer Patients

Ifad Kerim Alshibly

Journal of Advances in Medicine and Medical Research, Page 2684-2693
DOI: 10.9734/BJMMR/2014/7944

Aims: In Iraq, ovarian cancer is the fifth most common cause of death, and the 6th in the list of most common cancers. While TP53 is the most common tumor suppressor gene involved with human malignancies, ovarian cancer is already known to be linked to the variations in the breast cancer genes, BRCA1 and BRCA2. Herein we aim to estimate the rate of BRCA1, BRCA2 gene mutation and TP53 immuno-expression in patients with hereditary vs. sporadic ovarian cancer and to show the correlation of these biomarkers to some clinicopathological parameters.
Study Design: This is a correlational case-control study design.
Place and Duration of Study: The present study was performed in the Department of microbiology; Genetic section, College of Medicine, Babylon University. Samples taken from patients referred to general teaching hospitals and some of the private laboratories in Al-Hilla and Al-Najaf governorate, in the middle of Iraq, over a period from January 2013 to November 2013.
Methodology: Fifty-eight patients with ovarian carcinoma (30 sporadic and 28 hereditary), their ages ranging between 28-77 years, and thirty healthy women as control were included in this study. Genetic study using PCR technique was employed for BRCA1/2 gene mutation detection. Avidin-Biotin Complex (ABC) method was employed for immune-histochemical detection of Tp53 gene over-expression.
Results: BRCA1l2 gene mutation was found in 21 and 13 cases out of 28 hereditary and 30 sporadic ovarian cancer cases respectively. TP53 over-expression was detected in 18 and 17 cases out of 28 hereditary and 30 sporadic ovarian cancer cases. BRCA1l2 gene mutation and TP53 over-expression was reported more frequently in higher stage of tumor (P=0.05). The large majority of cases were diagnosed in later ages, patients with sporadic cancer got the disease later than hereditary ones.
Conclusion: BRCA1/2 and Tp53 genes alterations appears to be more important in hereditary than in sporadic ovarian cancer pathogenesis and evolution, as they are frequently associated with biologically aggressive tumors (high stages). Furthermore, TP53 gene over-expression was found to be more correlated with the cancer occurrence than BRCA1/2 mutation.

Open Access Original Research Article

Effect of Xylopia aethiopica, Fiscus mucuso and Anthocleista vogelli Extracts on Some Biochemical Parameters Following Ethanol-induced Toxicity

A. O. Ayoka, R. E Okonji, D. A. Ofusori, O. A. Komolafe, K. D. S. Bamitale, J. B. Fakunle

Journal of Advances in Medicine and Medical Research, Page 2705-2712
DOI: 10.9734/BJMMR/2014/7779

The objective of the study was to comparatively verify the effects of aqueous extracts of three plants on some biochemical parameters following ethanol administration with a view to ascertaining the role of the extracts in ameliorating ethanol toxicity.
A total of forty rats were divided into eight groups (n=5). Group A were control rats; Group B were administered with absolute ethanol; Group C were ethanol administered rats treated with Xylopia aethiopica; Groups D were ethanol administered rats treated with Fiscus mucuso, Group E were ethanol administered rats treated with Anthocleista vogelli; Group F were normal rats administered orally with Xylopia aethiopica; Group G were normal rats administered orally with Fiscus mucuso; Group H were normal rats administered orally with Anthocleista vogelli. At the end of the experimental period, the animals were sacrificed and serum was obtained for total protein, uric acid, creatinin, urea, aspartate aminotrasferase (AST) and alanine aminotransferase (ALT) analysis using respective research kits.
The result showed that Xylopia aethiopica had protective effect on the kidney as compared with Fiscus mucuso and Anthocleista vogelli treated rats. Also, The AST and ALT was lowered with the beginning of Xylopia aethiopia treatment. The total protein, creatinin and urea were slightly (p>0.05) affected with ethanol, an effect which was normalized with the beginning of extract treatment.
It can be concluded that Xylopia aethiopica had a better reno-protective and hepatoprotective effect than Anthocleista vogelli and Fiscus mucuso extract as evident in its ameliorative role on the biochemical profiles.

Open Access Original Research Article

Factors Associated with Exclusive Breastfeeding Practices among Mothers in Syria: A Cross-sectional Study

Nemeh Ahmad Al-Akour, Abidhakeem Okour, Roba Tawfig Aldebes

Journal of Advances in Medicine and Medical Research, Page 2713-2724
DOI: 10.9734/BJMMR/2014/8395

Background: Exclusive breastfeeding is the situation where the infant has received only breast milk from his/her mother for the first 6 months after birth. Research had found that factors associated with exclusive breastfeeding practices in different countries are varied. Little is known about exclusive breastfeeding in Syria.
Objective: To identify factors associated with exclusive breastfeeding practices among mothers in Syria.
Methodology: A cross-sectional study on feeding practices during the first 6 months of infant’s life was conducted in Lattakia City, the northwest of Syria from July through October 2012. A total sample of 334 Syrian mothers of infants aged between 0 and 12 months were studied on socio-demographic variables, reproductive factors, sources of breastfeeding support, and exclusive breastfeeding practices.
Results: About 83.5% of mothers were breastfeeding at the time of the study. At 4 months, 68.6% (229) of mothers were still exclusively breastfeeding, and 18.6% (62) continued to do so at 5 months. By 6 months, the breastfeeding prevalence rate fell to 12.9% (43). Binary logistic analysis for mothers who exclusively breastfed at 6 months and more showed that mothers who received husbands’ (P=0.027) and relatives’(P=0.007) advice not to add formula to breastfeeding were significantly associated with continuation of exclusive breastfeeding. Mothers of husbands with lower education (P=0.029) and mothers who did not smoke (P=0.002) were more likely to complete exclusive breastfeeding.
Conclusions: By 6 months of age, a large ratio of infants was not exclusively breastfed. Lower husband education, smoker mothers, husbands’ and relatives’ advice not to add formula to breastfeeding were identified as significant factors associated with exclusive breastfeeding among mothers in the study area in Syria.

Open Access Original Research Article

Determination of Self Satisfaction with Dental Appearance and Oral Health Status among a Population of Dentate Adults in a Referral Institution

Sunali Khanna, A. S. Gharpure

Journal of Advances in Medicine and Medical Research, Page 2725-2735
DOI: 10.9734/BJMMR/2014/5228

Aim: The aim of the study was to analyze how self- perceived satisfaction with dental appearance is affected by oral health status of an individual keeping in mind various socio-demographic factors.
Methodology: A sample size of 850 was obtained from the Out Patient Department of Nair Hospital Dental College in a cross sectional survey. The clinical oral health status was recorded after thorough clinical examination followed by measurement of Decayed, Missing Filled teeth (DMFT) and Oral Hygiene Index – Simplified (OHI-S). The questionnaire included socio-demographics and a single-item measuring self-reported satisfaction with appearance of teeth.
Results: Out of the total participants, 42.43% of the women and 37.7% of the men in this study were satisfied with their dental appearance. Odds ratio revealed that age, level of education, DMFT and OHI-S scores were inversely proportional to satisfaction with appearance of teeth. Multiple logistic regression analysis showed that OHI-S, DMFT and Education were the most significant factors (P < .05) to affect self-perceived dental appearance followed by gender and age.
Conclusion: Dissatisfaction with dental appearance was common in this hospital-based sample of young, middle-aged and older adults, and was significantly associated with key socio-demographic and oral health factors such as education, caries and oral hygiene status. Information from self-reports could help in planning effective strategies towards treatment to promote oral health.

Open Access Original Research Article

Research Ethics Education among Graduate Students of the University of Ibadan, Southwest Nigeria

K. O. Osungbade, T. O. Ogundiran, C. A. Adebamowo

Journal of Advances in Medicine and Medical Research, Page 2736-2749
DOI: 10.9734/BJMMR/2014/8523

Aims: Research ethics is an integral part of graduate education in developed countries; but little is known about exposure of graduate students in Nigeria to this subject. This study aimed to document the current teaching and knowledge of research ethics among graduate students of the University of Ibadan, Nigeria.
Study Design: A cross-sectional, exploratory study.
Place and Duration of Study: Four faculties (Basic Medical Sciences, Clinical Sciences, Dentistry and Public Health) of the College of Medicine, University of Ibadan, southwest Nigeria in July 2010.
Methodology: We interviewed 250 graduate students (40.4% males and 59.6% females) using a 55-item self-administered questionnaire to obtain data on general information and socio-demographic characteristics of the participants; research work during graduate students’ programme; knowledge of research ethics, research integrity and research misconduct; perception and practice of research ethics; and research ethics training needs.
Results: The mean age of study participants was 31.5±7.1 years; 82% received training on research ethics in current graduate work. 65.2% demonstrated good knowledge for research ethics and research misconduct separately and 51.2% for research integrity. Overall mean knowledge scores were 3.1±1.6 for research ethics, 2.5±2.0 for research integrity and 5.3±1.9 for research misconduct. Age and faculty location were predictors of knowledge of research integrity and research misconduct respectively.
Conclusion: It is desirable to integrate the existing structure of research ethics education. Expanding the scope of human development unit of tertiary institutions of learning to include capacity building and community engagement activities on research ethics for graduate students is suggested.

Open Access Original Research Article

Open Reduction with Internal Fixation of Proximal Humeral Fractures with Plates: Results of 20 Operated Patients

Bachir Ghostine, Amer Sebaaly, Tony Eid, Rami El Abiad

Journal of Advances in Medicine and Medical Research, Page 2750-2756
DOI: 10.9734/BJMMR/2014/7993

Introduction: This study evaluates the functional and radiological results of surgical treatment with plate and screws of proximal humeral fractures focusing on short and long-term complications.
Materials and Methods: This retrospective study was conducted at Hotel Dieu de France Hospital in Beirut. Inclusion criteria were: (1) Age >18 years old and (2) proximal humeral fracture operated on with the use of a plate (DCP (Dynamic compression plate) or LCP (Locking compression plate). Only 45 patients met these criteria since more than 70% of patients operated on were treated by other methods or dead. 20 patients presented to last follow up. Data collection included: Fracture type (using 2 classification: Codman/Neer and Hertel), early complications (infection, implant failure, stress riser fracture…), functional evaluation of the patient (using the “simple shoulder test”), and late complications (necrosis of the humeral head (NHH), malunion, osteoarthritis…) evaluated on x-rays by 2 independent physicians.
Results: Analysis of the 20 patients revealed 9 males and 11 females; with the mean age of 68 years and a mean follow up of 45 months. The most frequent type (60%) was a three-part fracture involving the great tuberosity. A standard 3,5 plate was used in 6 patients and a proximal humeral locking plate in 14, through a deltopectoral approach. There was neither early superficial nor deep infection. No vascular or neurological complications were noted. Mean SST score was 9.95. No differences between DCP and LCP fixation was noted (P=.27). Fixing tuberosities was not correlated with the SST (Simple Shoulder Test) score (P=.73). Latest x-ray evaluation showed 4 NHH. No correlation was found between functional outcome and the development of NHH (P=.18). Malunion was found in 6 patients (3 varus, 3 valgus). Perforation of the articular surface from long screws was noted in 3 patients. Intraarticular screw had no effect on functional outcome (P=.3).
Conclusion: With a careful preoperative patient’s selection and a good surgical technique, ORIF with both conventional and locking plates gives satisfactory functional results. AVN of the humeral head, when present, does not affect the shoulder’s function.

Open Access Original Research Article

Knowledge, Attitude and Beliefs of Caregivers of Children below 2 Years of Age towards Immunization

Nadia Abd El-Hamed Montasser, Randah Mohamad Helal, Noha Eladawi, Eman Mostafa, Fatma Abd El Rahman, Maged Saad, Soha Hamza

Journal of Advances in Medicine and Medical Research, Page 2757-2767
DOI: 10.9734/BJMMR/2014/8454

Aim: To determine the knowledge, attitude and beliefs of children below 2 years' caregivers towards immunization in an Egyptian community, to detect of the underlying causes of vaccination delay, and to determine their satisfaction regarding aspects of care.
Methodology: This cross sectional study was carried out on caregivers attending immunization setting in 5 urban and rural health facilities in Mansoura district, Egypt. They fill the questionnaire that asks about, Socio-demographic characteristics and different factors related to their attitude towards immunization.
Results: The study included 1000 caregiver in the study. We found that no caregiver refused to immunize his children and 10% only delayed their immunization which was mainly due to deficient information about the importance of vaccination. Caregivers who delayed vaccines compared with caregivers who regularly vaccinated their children were less likely to believe that vaccines are necessary to protect the health of children (91% vs. 99.3%, p<0.001), that their child might get a disease if they aren’t vaccinated(72% vs.83.3%, p<0.001), to read and watch stories about health (93% vs.100%, p<0.001), to agree with the statement, “vaccines are safe” (85% vs. 100%, p<0.001), to believe that they had a good relationship with their child’s health-care provider, (85% vs. 100%, p<0.001). At the same time, they reported lower satisfaction regarding different aspects of care except for insurances of proper vaccine administration.
Conclusion: Vaccination is one of the most effective public health interventions. Uptake of vaccination services is dependent not only on the quality of these services but also on other factors including knowledge and attitude of the parents. In this study we found that no one refused to immunize his children and the frequency of delayed vaccination was 10%. This delay was mainly due to insufficient information about the importance of vaccination, child illness, negative knowledge about the vaccines and vaccine deficiency. Health education programs is needed to explain different vaccines related worry together with improving different aspects of care that enhances caregivers satisfaction.

Open Access Original Research Article

Parallel Screening with Papanicolaou Smear and Visual Inspection Tests Significantly Reduced False Negative Screening Results in Southern Brazil

Evandro Russo, Emil Kupek

Journal of Advances in Medicine and Medical Research, Page 2783-2795
DOI: 10.9734/BJMMR/2014/8026

Aims: To verify the screening performance of Pap smear and four modalities of visual inspection tests (VIT) in screening for cervical intraepithelial neoplasia CIN of grade 2, 3 or carcinoma in situ, in a low risk population.
Study Design: A transversal study validated above tests, both in separate and in combination, against colposcopic and histologic examination as gold standard.
Place and Duration of Study: RFCC (Portuguese abbreviation for “Female network against cancer”) in Florianópolis, southern Brazil, between June 2010 and July 2012.
Methodology: Among 919 women eligible for the study, 882 completed all clinical and laboratory exams. All screen-positive and a random sample of 18.5% screen-negative specimen were submitted to colposcopy and, if necessary, histologic examination.
Results: The prevalence of CIN2 + in this study was 1.7%. Pap smear as the only screening test produced about 1/3 of false negative results. Among those considered normal by Pap smear, 32.1% were diagnosed as CIN1 and 17.1% as CIN2 + by histological examination. The false negative rate reduction from 6/15 for Pap smear test alone to 1/15 for its combination with VIT as a parallel test represents a 5/15 or 33.3% reduction (95% CI = 12-62%). The combination of all four VIT modalities into a parallel test also reduced the false negative fraction significantly.
Conclusions: This study has shown that Pap smear alone has its sensitivity too limited to be used as the only test in screening for cervical cancer. Adding VIT as a parallel test significantly improves the screening sensitivity by reducing the false negative results to less than 7% while maintaining the false negative rate at 8%.

Open Access Review Article

Prognostic Factors of Phyllodes Tumors of the Breast: Analysis of 170 Cases

Tarak Damak, Achraf Hadiji, Jamel Ben Hassouna, Amor Gamoudi, Riadh Chargui, Molka Chemlali, Khaled Rahal

Journal of Advances in Medicine and Medical Research, Page 2694-2704
DOI: 10.9734/BJMMR/2014/4979

Background: Phyllodestumors (PT) of the breast are rare and their prognosis and treatment are still subject of discussion. The purpose of this study is to determine the prognostic factors of this rare tumor.
Patients and Methods: We retrospectively reviewed the medical records of 170 patients who had histologically confirmed PT, collected over a period of 24 years in one single Institute (Salah Azaiz Institute).
Results: The mean age was of 38.7 years (14-75 years). The mean tumor size was 82.6 mm (15-300). According to criteria of WHO classification, tumors were classified into three groups: benign (97 cases, 57.1%), borderline (22 cases, 12.9%) and malignant (51 cases, 30%). One hundred and twenty eight patients (75.2%) were treated conservatively (96 benign, 17 borderline and 15 malignant) and 42 (24.7%) by radical surgery (6 borderline and 36 malignant). For malignant PT treated by local excision with or without reexcision of the tumor bed, the 5-year overall and recurrence free survivals were 46.2% and 44.2% vs. 55 and 63.8% when the surgery was radical (mastectomy with or without axillary dissection) (P=not significant and P=0.01). The rate of recurrence was 15.3 % (26) after a mean follow-up of 40 months (6 benign, 6 borderline and 14 malignant). Twelve patients developed metastases (7%). The 5-year overall and recurrence free survivals were 92.8% and 91.7%, respectively. In univariate analysis, age and recurrences are not of prognostic value for survival, while tumor size, histotype, necrosis, stromal overgrowth, cytonuclearatypia, tumor margins and number of mitosis were significant prognostic factors for survival. In multivariate study, stromal overgrowth and cytonuclearatypia remained independent predictors for survival. The tumor size and margins status were independent predictors for local recurrence.
Conclusion: According to our results, the most important factor for local recurrence is the tumor size and the margins status and for the overall survival is the stromal overgrowth and the cytonuclearatypia. The best treatment remains wide local excision for the benign forms while total mastectomy appears to be correlated to better recurrence free survival in large malignant PT.