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Management of cancer of the opposite breast Measuring microvascular density in tumors by following breast preservation retinol 05 acne buy cleocin gel in united states online. Breast cancer screening in women younger than 40: results conservation therapy in patients with from a statewide program acne xl buy cleocin gel 20gm amex. Celecoxib diagnosis of malignant and premalignant breast decreases prostaglandin E2 concentrations in nipple lesions combined with sentinel node biopsy: A aspirate fluid from high risk postmenopausal prospective clinical trial with 100 patients acne hormonal imbalance buy cleocin gel 20gm cheap. Cancer expression is an independent factor predictive of Detect Prev 2006; 30(4):322-8 skin care house philippines generic 20gm cleocin gel overnight delivery. Not ultrasonography in the detection of intraductal eligible target population spread of breast cancer: correlation with pathologic 2304 acne pictures purchase cleocin gel online from canada. Not eligible target Japanese postmenopausal women with early breast population cancer skin care olive oil order cleocin gel online pills. Not eligible target population Intensity over Time Pre and Post-administration of 2293. Zentralbl Gynakol 2002 Accumulation of genetic alterations and progression Feb; 124(2):104-10. Fine needle specimen: potential use in selecting patients for aspiration cytology in the work-up of intraoperative radiotherapy. Ann Surg Oncol 2008 mammographic and ultrasonographic findings in Mar; 15(3):833-42. Not eligible outcomes breast cancer screening: an attempt at differentiating 2307. Breast aspirate cytology and pathologic parameters predict Cancer Res Treat 2004 Apr; 84(3):247-50. Not residual cancer and nodal involvement after eligible outcomes excisional breast biopsy. Not eligible outcomes Randomized trial of tamoxifen versus tamoxifen plus aminoglutethimide as adjuvant treatment in B-89 postmenopausal breast cancer patients with treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2008 carcinoma in situ of the breast: a population-based Nov 19; 100(22):1568-70. Not eligible target oestrogen-dependent growth towards an population autonomous growth in breast carcinogenesis. J Pathol 1995 Jul; Clinical and pathological features of breast disease 176(3):233-41. Histologic sampling of Symmetrization reduction mammaplasty combined grossly benign breast biopsies. Int J Cancer 2003 Sep 10; expression variation between distinct areas of breast 106(4):611-8. Not eligible target Microscopic residual disease is a risk factor in the population primary treatment of breast cancer. Not eligible level of the nipple/areola complex in oncoplastic surgery of evidence after central quadrantectomy. Not eligible level ultrasonographically guided large core needle of evidence biopsy: correlation with mammographic and 2333. J Ultrasound Med 2000 Jul; morbidity of patients with early breast cancer after 19(7):449-57. J Surg Oncol 2006 Feb 1; radiation therapy for ductal carcinoma in-situ of the 93(2):109-19. Breast the mammography screening pilot project in reconstruction in women treated with radiation Wiesbaden, Germany. J Cancer Res Clin Oncol therapy for breast cancer: cosmesis, complications, 2008 Jan; 134(1):29-35. The use of carcinoma in situ of the breast: relationship to the tissue expanders in immediate breast reconstruction degree of differentiation. Phase 2 randomized trial of primary endocrine Treatment by local excision and surveillance alone. Not eligible patients with estrogen receptor-positive breast level of evidence cancer. Predictors of multicentricity and microinvasion and Spectrum of mammographically detected breast implications for treatment. Detailed deletion Not eligible outcomes mapping in sporadic breast cancer at chromosomal 2359. Involvement of collagenous calcifications in and around breast carcinoma: a spherulosis by lobular carcinoma in situ. An evidence disease fluid protein-15, -24 and -44 in ductal based estimation of local control and survival B-91 benefit of radiotherapy for breast cancer. Case report microdissected tissue of breast carcinoma: an and dosimetric analysis of an axillary recurrence implication for mutator phenotype and breast cancer after partial breast irradiation with mammosite pathogenesis. Breast cancer polymorphisms in the cyclooxygenase-2 gene, use recurrences in elderly patients after lumpectomy. Microsatellite Immunohistochemistry increases the accuracy of alterations on human chromosome 11 in in situ and diagnosis of benign papillary lesions in breast core invasive breast cancer: a microdissection needle biopsy specimens. Cancer 2002 Jan 15; lecithin:retinol acyltransferase expression in human 94(2):305-13. Intratumoral Not eligible outcomes concentration of sex steroids and expression of sex 2369. Failure of steroid-producing enzymes in ductal carcinoma in high risk women to produce nipple aspirate fluid situ of human breast. Endocrine-related cancer 2008 does not exclude detection of cytologic atypia in Mar; 15(1):113-24. Breast Cancer Res Treat 2004 Sep; Cyclooxygenase-2 expression is related to nuclear 87(1):59-64. Not eligible target population grade in ductal carcinoma in situ and is increased in 2370. Cancer Res 2003 analysis of minimally invasive microductectomy May 15; 63(10):2347-50. Surgery 2005 Oct; detected and symptomatic ductal carcinoma in situ: 138(4):591-6; discussion 6-7. South Med J performed if lobular carcinoma in situ is seen on 1992 Feb; 85(2):207-9. Am J Surg ductal carcinoma in situ: A paradoxical role for Pathol 2004 Jun; 28(6):789-93. Cancer 1998 regulation of the oestrogen receptor in benign breast Jun 15; 82(12):2382-90. Am J Clin Oncol 1991 Dec; receptor expression in the normal and pre-cancerous 14(6):534-7. Not eligible Breast cancer diagnosis and prognosis in women outcomes augmented with silicone gel-filled implants. X-ray scattering assisted needle biopsy of suspicious breast for classifying tissue types associated with breast microcalcifications. Not eligible target population improves the management of patients with breast 2415. Heterogeneous expression of nm23 gene product in Kin-cohort estimates for familial breast cancer risk noninvasive breast carcinoma. Breast Cancer (Weddellite) within the secretions of ductal Res Treat 2004 Jan; 83(1):1-10. Surgical formation after rectus flap breast reconstruction: palliation for pancreatic cancer. Novel mastectomy and immediate reconstruction: translational model for breast cancer oncologic risks and aesthetic results in patients with chemoprevention study: accrual to a presurgical early-stage breast cancer. Carcinoma and atypical and tamoxifen administration before definitive hyperplasia in radial scars and complex sclerosing surgery for breast neoplasia. Not eligible target population carcinoma in situ of the breast with different 2425. Postmastectomy histopathological grades and corresponding new brachial plexus injury exacerbated by tissue breast tumour events: analysis of loss of expansion. Biopharm Drug Dispos biopsy at the time of treatment of primary breast 1997 Dec; 18(9):779-89. Am J neurologic symptoms during peripheral stem cell Dermatopathol 1985 Aug; 7(4):335-40. Not eligible apheresis in two patients with intracranial target population metastases. Letrozole versus tamoxifen in the expression in the spectrum of preinvasive breast treatment of advanced breast cancer and as lesions. Report of continuous infusional 5-fluorouracil-based three cases with immunohistochemical and chemotherapy regimen compared with conventional ultrastructural examination. Virchows Arch 2002 chemotherapy in the neo-adjuvant treatment of early Jan; 440(1):29-35. Not eligible target Benign papilloma on core biopsy requires surgical population excision. Not eligible-target population treatment of postmenopausal breast cancer with B-94 anastrozole, tamoxifen, or both in combination: the women from a population screening trial. Ann Acad Immediate Preoperative Anastrozole, Tamoxifen, or Med Singapore 2000 Jul; 29(4):457-62. Br Med J classification of breast cancer morphology (Clin Res Ed) 1981 Nov 28; 283(6304):1432-4. Atypical ductal tamoxifen and aminoglutethimide in the treatment hyperplasia: improved accuracy with the 11-gauge of advanced breast carcinoma. Cancer Res 1982 vacuum-assisted versus the 14-gauge core biopsy Aug; 42(8 Suppl):3430s-3s. Salvage placebo-controlled trial of neoadjuvant anastrozole treatment for local recurrence following breast alone or with gefitinib in early breast cancer. J Clin conserving surgery and definitive irradiation for Oncol 2007 Sep 1; 25(25):3816-22. Not eligible ductal carcinoma in situ (intraductal carcinoma) of target population the breast. Not treatment for local recurrence after breast eligible outcomes conserving surgery and radiation as initial treatment 2449. Association of clinical and treatment for local or local-regional recurrence after pathologic variables with lumpectomy surgical initial breast conservation treatment with radiation margin status after preoperative diagnosis or for ductal carcinoma in situ. Cancer ductal hyperplasia diagnosis by directional vacuum 1990 Mar 1; 65(5):1085-9. Considerations for surgical significance of the pathology margins of the tumor excision. Am J Clin Pathol 2003 Feb; 119(2):248 excision on the outcome of patients treated with 53. Fine-needle aspiration Int J Radiat Oncol Biol Phys 1991 Jul; 21(2):279 cytology of ductal hyperplasia with and without 87. Clinical, Int J Radiat Oncol Biol Phys 1990 Oct; 19(4):843 histopathologic, and biologic features of 50. Not eligible level of evidence pleomorphic lobular (ductal-lobular) carcinoma in 2466. Mod Pathol ductal carcinoma of the breast treated with breast 2002 Oct; 15(10):1044-50. Not carcinoma-in-situ of the breast: fine-needle eligible target population aspiration cytology of 12 cases. Breast carcinoma and overexpression and histological type of in situ and secondary acute lymphoblastic leukaemia invasive breast carcinoma. Breast cancer prevention using responsive ezrin-radixin-moesin-binding calcium and vitamin D: a bright futurefi J Natl pathologic correlation of results of needle-directed Cancer Inst 1975 Feb; 54(2):335-9. Sonographic discovery of occult breast carcinoma in twins: case detection and sonographically guided biopsy of reports. Papillary recurrence seventeen years after subcutaneous carcinoma of the breast: imaging findings. Am sparing mastectomy-initial experience at a tertiary Surg 1993 Feb; 59(2):69-73. Echogenicity Mammographically detected breast cancer: location of breast cancer: is it of prognostic valuefi M34 actin regulatory protein that influence surgical choices in women with is a sensitive diagnostic marker for early and late breast carcinoma. No mass image-forming lesions on breast associated hypothesis tested ultrasonography. Evaluating post Not eligible target population treatment screening in women with breast cancer. Not breast cancer, as studied by use of two-dimensional eligible target population B-96 electrophoresis. Cancer 1992 Jun 15; 69(12):2965 end point biomarker trial of perillyl alcohol in 8. Terminal duct lobular units are Case Reports scarce in the nipple: implications for prophylactic 2501. Case report: breast nipple-sparing mastectomy: terminal duct lobular cancer in males-a genetic consideration. Placental predicting an extensive intraductal component in site trophoblastic tumor associated with immature early-stage infiltrating ductal carcinoma. The Scottish trial of adjuvant tamoxifen mammography-guided fine-needle aspirates of in node-negative breast cancer. Long term Mammographic predictors of the presence and size analysis of factors influencing the outcome in of invasive carcinomas associated with malignant carcinoma of the breast smaller than one centimeter. Not eligible target population carcinoma of the breast after oophorectomy and 2510.

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High-risk endometrial cancer subgroups: candidates for target-based adjuvant therapy acne gone order discount cleocin gel on-line. The selective use of vaginal hysterectomy in the management of adenocarcinoma of the endometrium acne 5 cleocin gel 20 gm low price. Use of vaginal hysterectomy for the management of stage I endometrial cancer in the medically compromised patient acne aid soap purchase cleocin gel without prescription. Vaginal hysterectomy as primary treatment of endometrial cancer in medically compromised women skin care 1 month before wedding generic 20gm cleocin gel overnight delivery. A comparison of laparoscopic management of endometrial cancer with traditional laparotomy acne no more order 20 gm cleocin gel. Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges skin care reddit buy cleocin gel from india. Cost and quality-of-life analyses of surgery for early endometrial cancer: laparotomy versus laparoscopy. Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma. Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer: a prospective randomized trial. Low incidence of port-site metastases after laparoscopic staging of uterine cancer. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a Gynecologic Oncology Group study. Extra-peritoneal laparoscopic para-aortic lymphadenectomy: a prospective cohort study of 293 patients with endometrial cancer. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese womanfi Role of wide/radical hysterectomy and pelvic lymph node dissection in endometrial cancer with cervical involvement. Irradiation of endometrial cancer in patients with medical contraindication to surgery or with unresectable lesions. What can be expected when radiation therapy becomes the only curative alternative for endometrial cancerfi Results of intracavitary radium treatment for adenocarcinoma of the body of the uterus. Medically inoperable stage I adenocarcinoma of the endometrium treated with radiotherapy alone. Radiation therapy alone for medically inoperable patients with adenocarcinoma of the endometrium. Stage I endometrial carcinoma: treatment of nonoperable patients with intracavitary radiation therapy alone. Post-operative high dose rate brachytherapy in patients with low to intermediate risk endometrial cancer. Adjuvant vaginal high-dose-rate afterloading alone in endometrial carcinoma: patterns of relapse and side effects following low-dose therapy. Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer. Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multi-institutional experience. Radiation therapy for surgically proven para-aortic node metastasis in endometrial carcinoma. Endometrial cancer with para-aortic adenopathy: patterns of failure and opportunities for cure. Role of whole abdominal radiation therapy in the management of endometrial cancer; prognostic importance of factors indicating peritoneal metastases. Treatment of intraperitoneal metastatic adenocarcinoma of the endometrium by the whole-abdomen moving-strip technique and pelvic boost irradiation. Postoperative whole abdomino-pelvic irradiation for patients with high-risk endometrial cancer. Whole abdominal radiation in endometrial carcinoma: an analysis of toxicity, patterns of recurrence, and survival. Treatment of high-risk uterine cancer with whole abdominopelvic radiation therapy. Adjuvant progestogen therapy in the primary definitive treatment of endometrial cancer. A randomized trial of progestogens in the primary treatment of endometrial carcinoma. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer: results from two randomised studies. Combined surgery and radiation in endometrial carcinoma: an analysis of prognostic factors. Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Vaginal recurrences of endometrial carcinoma: the prognostic value of staging by a primary vaginal carcinoma system. Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis. Prognostic factors and treatment outcome for patients with locally recurrent endometrial cancer. Medroxyprogesterone acetate (Depo-Provera) versus hydroxyprogesterone caproate (Delalutin) in women with metastatic endometrial adenocarcinoma. Oral medroxyprogesterone acetate in advanced or recurrent endometrial carcinoma: results of therapy and correlation with estrogen and progesterone receptor levels. Current status and future innovations of hormonal agents, chemotherapy and investigational agents in endometrial cancer. Topotecan is an active agent in first line treatment of metastatic or recurrent endometrial carcinoma. Prospective treatment of advanced or recurrent endometrioid carcinoma with cisplatin, doxorubicin, and cyclophosphamide. Surveillance for recurrent endometrial carcinoma: development of a follow up scheme. Feasibility of ovarian preservation in patients with early stage endometrial carcinoma. A need for laparoscopic evaluation of patients with endometrial carcinoma selected for conservative treatment. Estrogen replacement therapy in endometrial cancer patients: a matched control study. Mesenchymal and mixed epithelial-mesenchymal tumors of the uterine corpus and cervix. Endometrial stromal nodules and endometrial stromal tumors with limited infiltration: a clinicopathologic study of 50 cases. Endometrial stromal sarcoma metastatic to the lung: a detailed analysis of 16 patients. Primary uterine endometrial stromal neoplasms: a clinicopathologic study of 117 cases. Uterine tumors resembling ovarian sex-cord tumors: a clinicopathologic study of fourteen cases. Uterine tumor resembling ovarian sex-cord tumor: a case report and review of the literature. Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Problematic uterine smooth muscle neoplasms: a clinicopathologic study of 213 cases. Epithelioid smooth muscle tumors including leiomyoblastoma and clear cell leiomyoma: a clinical and pathologic analysis of 26 cases. Epithelioid smooth muscle tumors of the uterus: a clinicopathologic study of 18 patients. Intravenous leiomyomatosis of the uterus: a clinicopathologic analysis of 16 cases with unusual histologic features. Efficacy of oophorectomy in lymph-angioleiomyomatosis and benign metastasizing leiomyoma. Peritoneal leiomyomatosis (leiomyomatosis peritoneal disseminata): a clinicopathologic study of 20 cases with ultrastructural observations. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus: a Gynecologic Oncology Group pathologic study of 203 cases. Analysis of clinicopathologic factors in malignant mixed mullerian tumors of the uterine corpus. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinoma of the uterus. Prognostic factors in malignant mesodermal (mullerian) mixed tumors of the uterus. Prognostic value of peritoneal washings in patients with malignant mixed mullerian tumors of the uterus. Mullerian adenosarcoma of the uterus: a clinico-pathologic analysis of 100 cases with a review of the literature. Uterine sarcomas: analysis of failures with special emphasis on the use of adjuvant radiation therapy. Surgical resection of pulmonary and extrapulmonary recurrences of uterine leiomyosarcoma. Results of postoperative radiotherapy in the treatment of sarcoma of the corpus uteri. Adjuvant pelvic radiotherapy for uterine carcinosarcoma in a high-risk population. A comparison between different postoperative treatment modalities of uterine carcinosarcoma. Systemic therapy for advanced uterine sarcoma: a systemic review of the literature. A randomized study of adriamycin with and without triazenoimidazole carboxamide in advanced uterine sarcomas. Paclitaxel in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Clinical experiences with combination paclitaxel and carboplatin therapy for advanced or recurrent carcinosarcoma for the uterus. A randomized clinical trial of adjuvant adriamycin in uterine sarcomas: a Gynecologic Oncology Group study. Cervical cancer is clinically staged, although modern radiographic modalities such as computed tomography, magnetic resonance imaging, ultrasound, or positron emission tomography may be beneficial for individual treatment planning. Radiation therapy is the mainstay of treatment for most patients; however, select patients may be treated with radical surgery. Cervical cancer ranks as the third most common gynecologic neoplasm in the United States, behind cancer of the corpus and ovary, mainly as a result of the effectiveness of screening programs. In developing countries, where health care resources are limited, cervical carcinoma is the second most frequent cause of cancer death in women. Because cervical cancer is preventable, it is imperative that gynecologists and other primary health care providers to women be familiar with vaccination programs, screening techniques, diagnostic procedures, and risk factors for cervical cancer and management of preinvasive disease. Vaginal cancer is a rare tumor that shares an epidemiology and risk factor profile that is similar to cervical cancer. Cervical Cancer Epidemiology and Risk Factors Invasive cancer of the cervix is considered a preventable disease because it has a long preinvasive state, cervical cytology screening programs are currently available, and the treatment of preinvasive lesions is effective. In spite of the preventable nature of this disease, 12,710 new cases of invasive cervical cancer resulting in 4290 deaths were anticipated in the United States in 2011 (1). Although screening programs in the United States are well established, it is estimated that 30% of cervical cancer cases will occur in women who have never had a Papanicolaou (Pap) test. Nevertheless, the worldwide incidence of invasive disease is decreasing, and cervical cancer is being diagnosed earlier, leading to better survival rates (1,3). The mean age for cervical cancer in the United States is 47 years, and the distribution of cases is bimodal, with peaks at 35 to 39 years and 60 to 64 years of age (1). There are numerous risk factors for cervical cancer: young age at first intercourse (younger than 16 years), multiple sexual partners, cigarette smoking, race, high parity, low socioeconomic status, and chronic immune suppression. Some investigators proposed that use of oral contraceptives might increase the incidence of cervical glandular abnormalities; however, this hypothesis was not consistently supported (4,5). Many of these risk factors are linked to sexual activity and exposure to sexually transmitted diseases. Both steps are essential for the malignant transformation of cervical epithelial cells.

The glandular epithelium is composed of numerous ridges acne yogurt order cleocin gel 20 gm on line, clefts skin care network cheap cleocin gel 20gm without prescription, and infoldings and acne 7 days after ovulation order 20gm cleocin gel otc, when covered by squamous metaplasia acne in early pregnancy cheap 20 gm cleocin gel mastercard, leads to the appearance of gland openings skin care 08 best cleocin gel 20gm. Technically acne during pregnancy buy cleocin gel with mastercard, the endocervix is not a gland, but often the term gland openings is used. Under stimulation of lower vaginal acidity, the reserve cells proliferate, lifting the columnar epithelium. The immature metaplastic cells have large nuclei and a small amount of cytoplasm without glycogen. As the cells mature normally, they produce glycogen, eventually forming the four layers of epithelium. The metaplastic process begins at the tips of the columnar villi, which are exposed first to the acid vaginal environment. As the metaplasia replaces the columnar epithelium, the central capillary of the villus regresses, and the epithelium flattens out, leaving the epithelium with its typical vascular network. As metaplasia proceeds into the cervical clefts, it replaces columnar epithelium and similarly flattens the epithelium. The deeper clefts may not be completely replaced by the metaplastic epithelium, leaving mucus-secreting columnar epithelium trapped under the squamous epithelium. Some of these glands open onto the surface; others are completely encased, with mucus collecting in nabothian cysts. Their significance was not recognized until 20 years later, when Meisels and colleagues reported these changes in mild dysplasia (7) (Fig. However, a cell culture system for growing keratinocytes was described that allows for stratification and differentiation of specific keratinase types (14). The E6 and E7 oncoproteins are identifiable in the transfected cell lines, providing strong laboratory evidence of a cause-and-effect relationship (15). The normal maturation process and differentiation from the basal and parabasal layers to the intermediate and superficial layers are maintained. In the upper layers, koilocytes are characterized by perinuclear halos, well-defined cell borders, and nuclear hyperchromasia, irregularity, and enlargement. Most women who are exposed have no clinical evidence of disease, and the infection is eventually suppressed or eliminated (17). Factors that may have a role in persistence and progression include smoking, contraceptive use, infection with other sexually transmitted diseases, or nutrition (17,22). This suggests that past exposure and clearance of the virus does not reduce the efficacy of the vaccine. The 3-year follow-up studies of both vaccine products exhibit a reduction in referrals to colposcopy by 26% and 20%, respectively (29,35). This is accompanied by a reduction in excisional procedures of 69% and 42% for the bivalent and quadrivalent products, respectively (29,35). In the vaccine trials in men and boys the protection was 89% at 29 months, leading to approval of this quadrivalent vaccine in males (37). The vaccines are approved for women up to 26 years of age and to be protective they should be effective beyond 10 years. In order to induce a significant antibody response to the antigen, it is combined with an adjuvant. By contrast, the bivalent adjuvant is an aluminum hydroxide combined with a monophosphoryl lipid A. This adjuvant produced higher antibody titers than aluminum-induced titers at the 4-year follow-up visit (39). Because the first vaccinations were given less than 10 years ago, the studies to determine the advisability of a booster are ongoing. The American Committee on Immunization Practices developed recommendations for the utilization of both the quadrivalent and bivalent vaccines in young girls and women. In 2007 the American Cancer Society issued a set of clinical guidelines that remain relevant to the use of these agents (40). For young women between the ages of 19 to 26, there are insufficient data to determine the value of universal vaccination. Screening practices for cervical intraepithelial neoplasia and cancer should remain unchanged in both vaccinated and unvaccinated women. A standardized method of reporting cytology findings facilitated peer review and quality assurance. Pap Test Accuracy Screening for cervical cancer precursors using exfoliative cervico-vaginal cytology, the Pap test was successful in reducing the incidence of cervical cancer by 79% and the mortality by 70% since 1950 (50). However, 20% of women in the United States do not undergo regular screening and have not had a Pap test in the previous 3 years. Some cases of cervical cancer continue to occur in patients who have regular Pap tests. A literature review of cervical cytology testing techniques was conducted by the Agency for Healthcare Research and Quality (53). The conclusion was that the sensitivity of conventional cytologic testing in detecting cervical cancer precursor lesions was 51%, with an estimated false-negative rate of 49%. Nearly 30% of new cancer cases each year occur among women who underwent Pap testing. Errors of sampling, fixation, interpretation, or follow-up may be responsible for the missed cases (57). Prior overestimates of Pap test sensitivity of approximately 80% led to erroneous recommendations of screening frequency (58). The conventional Pap test technique needs to be improved in order to reduce false negative errors. Sampling errors occur because a lesion is too small to exfoliate cells or the device did not pick up the cells and transfer them to the fixation media. Historically, preparation errors occurred because of poor fixation on the glass slide, leading to air drying and its consequences for interpretation. The slide preparations could be too thick and obscured by vaginal discharge, blood, or mucus. These problems were obviated with the widespread utilization of liquid-based media. Interpretive errors may still occur when the slide contains diagnostic cells that the screening technician or automated detection device fails to identify. The ubiquitous use of liquid-based medium to collect the cytologic sample and preserve the collected cervical cells significantly decreased specimen sampling and preparation errors. With this technique, liquid samples are processed to provide a uniform, thin layer of cervical cells without debris on a glass slide. The Agency for Healthcare Research and Quality assessment of liquid-based cytology improved the sensitivity of the Pap test to the stated goal of 80%. The cell sample is collected with an endocervical brush used in combination with a plastic spatula or with a plastic broom. With this technique, 80% to 90% of the cells are transferred to the liquid media, as compared with the 10% to 20% transferred to the glass slide with conventional cytologic testing. The cells are retrieved from the vial by passing the liquid through a filter, which traps the larger epithelial cells, separating them from the small blood and inflammatory cells. This process yields a thin layer of diagnostic cells properly preserved and more easily interpreted by the cytologist. This technique reduces by 70% to 90% the rate of unsatisfactory samples encountered with conventional cytologic testing (59). Liquid-based cytology is commonly performed by most of the laboratories in the United States. The system scans the slide and uses computer imaging techniques to analyze each field of view on the slide. Computer algorithms rank each slide on the probability that the sample may contain an abnormality. Bethesda System Modifications the Bethesda System for reporting the results of cervical cytology developed as a uniform system of cytology reporting that would provide clear guidance for clinical management (45). It creates a standardized framework for laboratory reports that includes a descriptive diagnosis and an evaluation of specimen adequacy. The Bethesda System was modified to reflect the development of new technologies and research findings. In the Bethesda System, specimen adequacy is categorized as satisfactory or unsatisfactory for evaluation. If a specimen is found to be unsatisfactory, cervical cytology is repeated promptly. If sampling of the transformation zone is inadequate or obscuring factors are present, cervical cytology can be repeated in 6 to 12 months. The general categorizations are (i) negative for intraepithelial lesion or malignancy, (ii) epithelial cell abnormality, and (iii) other. In the category of negative for intraepithelial lesions or malignancy, evidence for the presence of trichomonas vaginalis, candida, bacterial vaginosis, actinomyces, and herpes simplex virus may be noted. Included in this category are reactive cellular changes, glandular cells status after hysterectomy, and atrophy. The category epithelial cell abnormality includes squamous cell and glandular cell abnormalities. Ancillary Testing Provide a brief description of the test methods and report the result so that it is easily understood by the clinician. Cervical Cancer Precursors Guidelines based on the literature were developed to guide cervical cancer screening, follow-up, and treatment. Ultimately guidelines cannot substitute for an informed discussion of risks and benefits between a patient and health care provider in order to make decisions about treatment. If liquid-based cytology is being used, screening can be extended to every 2 years. Screening should begin at the age of 21 or within 3 years of the onset of sexual activity, and screening can stop at age 70 if there were no abnormal Pap test result in the previous 10 years. This acknowledges the very low prevalence of invasive cancer in very young women, the long multiyear process of cervical carcinogenesis, and the very low but real risks for preterm birth associated with outpatient excisional procedures. Likewise screening frequency was revised to every 2 years from age 21 to 29 (with either conventional slide or liquid-based cytology), and every 3 years for women after age 30 years if three consecutive negative, i. Discontinuation of screening is reasonable between 65 to 70 years, with reassessment of risk factors annually to determine if reinitiating screening is appropriate. When the results of both tests are negative, the woman does not have to be retested for 3 years. About 50% of patients will undergo colposcopy because of subsequent abnormal Pap test results, making this option nearly as costly as immediate colposcopy (69). Because 80% of patients will not have significant lesions, it is important to avoid overinterpretation of the colposcopic findings and to be conservative in performing biopsies. There were 1,163 women in the immediate colposcopy group, and 14 refused the examination. After colposcopically directed biopsy and determination of the distribution of the lesion, excisional or ablative therapy that addresses the entire transformation zone should be performed. The application of acetic acid coagulates the proteins of the nucleus and cytoplasm and makes the proteins opaque and white (5). The acetic acid does not affect mature, glycogen-producing epithelium because the acid does not penetrate below the outer one-third of the epithelium. The cells in this region have very small nuclei and a large amount of glycogen (not protein). They appear slightly white, particularly in the presence of the beginning signs of metaplasia. The immature metaplastic cells have larger nuclei and show some effects of the acetic acid. In colposcopic terminology, this plaque is white epithelium, visible before application of acetic acid. Immature squamous epithelial cells have the potential to develop into keratin-producing cells or glycogen-producing cells. Leukoplakia should not be confused with the white plaque of a monilial infection, which can be completely wiped off with a cotton-tipped applicator. Because it is not possible to see through the thick keratin layer to the underlying vasculature during colposcopy, such areas should undergo biopsy to rule out keratinizing carcinoma. Punctation Dilated capillaries terminating on the surface appear from the ends as a collection of dots and are referred to as punctation (Fig. The punctate vessels are formed as the metaplastic epithelium migrates over the columnar villi. The central capillaries of the columnar villi are preserved and produce the punctate vessels on the surface. Mosaic Terminal capillaries surrounding roughly circular or polygonal-shaped blocks of acetowhite epithelium crowded together are called mosaic because their appearance is similar to mosaic tile (Fig. They may arise from a coalescence of many terminal punctate vessels or from the vessels that surround the cervical gland openings (5). This pattern develops as islands of dysplastic epithelium proliferate and push the ends of the superficial blood vessels away, creating a pattern that looks like mosaic tiles. Atypical Vascular Pattern Atypical vascular patterns are characteristic of invasive cervical cancer and include looped vessels, branching vessels, and reticular vessels. In cases when an endocervical sample is needed, a cytobrush is sufficient for sampling the endocervical canal. Cervical Biopsy the cervical biopsy is performed at the area most likely to have dysplasia.

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In one study acne 5 weeks pregnant cheap 20 gm cleocin gel with visa, participants who were threatened with negative feedback on an intelligence task showed more stereotyping in their judgments of a gay male than those who received neutral feedback (Fein & Spencer acne wipes discount 20 gm cleocin gel free shipping, 1997) acne jokes discount cleocin gel 20gm with visa. Thus acne 40s purchase cleocin gel 20 gm mastercard, selffithreatening feedback can exacerbate outgroup derogation and the use of stereotypes skin care with vitamin c buy cleocin gel line. This finding suggests that selffiimage maintenance concerns can motivate prejudicial responses acne light purchase cleocin gel no prescription. Fein and Spencer (1997) examined this possibili ty in one study where participants completed a selffiaYrmation through writing about an important value (versus a control condition where they wrote about a relatively unimportant value). Thus, the extent to which a person is threatened or aYrmed will aVect whether or not they are likely to make prejudicial judg ments of an outgroup member (cf. Indeed, in this study, selffiaYrmation did not simply attenuate preju dice and discrimination but eliminated it. Comparing oneself to another person who is faring worse is another way that people may aYrm selffiintegrity via social perception. When people have a vulnerable or easily threatened selffiimage, they generally respond with downward social comparisons (Taylor & Lobel, 1989; Wills, 1981). Shelley Taylor and her colleagues (Taylor, Wood, & Lichtman, 1983) found that women with breast cancer responded to their highly threatening situation by making downward social comparisons. They would assert that their illness was, at least, less severe than that of another patient, or that they were coping with their illness better than others. These downward comparisons, Taylor suggested, helped patients to maintain a sense of worth in a situation where they struggled to maintain their sense of control, predictability, and optimism. If people engage in downward social comparisons to compensate for a threatened selffiimage, then they should engage in them to a lesser extent when selffiaYrmed. Indeed, they may even be more prone to engage in upward comparisons that they might otherwise view as threatening (Spencer, Fein, & Lomore, 2001). In one study, college students completed a test of intelli gence, and they were informed that they performed at the 47th percentile. Half of the students then had the opportunity to aYrm the self by writing an essay about an important value, whereas the other half wrote about an unimportant value. Then the participants, in a separate task, were informed that another participant would interview them. For the ostensible purpose of preparing them for their interview, they then listened to excerpts of two previous interviews. This choice provided an opportunity to make an upward comparison (if they selected the superior interviewee) or a downward comparison (if they selected the inferior interviewee). In the nofiaYrmation condition, the participants generally made downward comparisons, as 83% chose to hear the inferior interviewee. By contrast, among those who completed the selffiaYrmation, 83% chose to hear the superior interviewee, making an upward social com parison. Once again, selffiaYrmation reduced threat and thereby encouraged people to expose themselves to an informative but potentially threatening learning opportunity. In summary, predictions derived from selffiaYrmation theory (Steele, 1988) have been supported in a wide range of situations involving selffithreat. When selffiintegrity is aYrmed, people are less biased in their judgments of information related to their political identity (Cohen et al. SelffiaYrmation inoculates people against threat, and thus makes them more open to ideas that would otherwise be too painful to accept. Theoretically consistent eVects of selffiaYrmation have been found on selffireport measures, physiological responses, and behavior. When selffiintegrity is secured, people seem less concerned with the selffievaluative implications of social experiences and are more likely to engage their social world in a nonfidefensive, open manner. The research detailed in the previous sections extends this theorizing to many other situations where people contend with events that challenge a personal identity. A major advance in selffiaYrmation theory concerns its relevance to the way people cope with threats to their social. Consequently, people will defend against threats to collective aspects of the self much as they defend against threats to individual or personal aspects of self. The selffiaYrmation analysis of such collective threats, however, asserts that because social identities are only one part of a larger, fiexible selffi system, people can respond to threats to their group memberships or social identities indirectly. That is, they can maintain an overall selffiperception of worth and integrity by aYrming some other aspect of the self, unrelated to their group. This insight has applications to a wide range of phenomena related to group identity. However, social groups are a central part of how people see themselves, and people are motivated to defend their social identities (Abrams & Hogg, 1988). Consequently, when explaining the success or failure of their group, people tend to be defensive and group serving. This phenomenon has been observed in several studies examining attributions made for success or failure in real world contexts. Letters to shareholders feature more internal attributions after successful years. In two field studies involving intramural sports team athletes as partici pants, Sherman and Kim (2005) examined the role of the selffiintegrity motivations in groupfiserving judgments. The intramural sports teams, consisting of voluntarily formed groups of friends, played their games where they either won or lost and then participated in the study. They completed a selffiaYrmation manipulation in which they filled out a values scale concerning either their most important value or a relatively unimportant value. Overall, the athletes were both selffiserving and group serving in their attributions. Both selffi and groupfiserving biases, however, were eliminated among those who completed a selffiaYrmation. A second goal of this research focused on examining the relation between selffi and groupfiserving judgments. People generalize their positive evaluation of self to their evaluation of their group. However, if the need to protect selffiintegrity is satisfied via selffiaYrmation, then people should be able to evaluate the group independently of how they evaluate the self. We examined whether such selffigroup anchoring would be attenuated by a selffiaYrmation (Sherman & Kim, 2005, Study 2), again with intra mural athletes who had just won or lost a game. We replicated the basic findings that selffiaYrmation reduced both the selffi and the groupfiserving attributional biases. Additionally, we examined the correlations between the attributions to the self and the attributions to the group as a function of aYrmation condition. In contrast, when participants were selffiaYrmed in an alternative domain, they evaluated the group independently of their selffievaluations, as the corre lation was eliminated (r fiA. SelffiaYrmation, then, allows people to evaluate their groups independently of the way they evaluate themselves. On the other hand, there were those who took a critical eye to American foreign policies and noted how these policies (such as its support of totalitarian regimes in the Middle East) may have sowed the conditions and sense of disenfranchisement among that populace, which contributed, in part, to the terrorist acts against the United States. The report argued that Islamic terrorism can be understood in terms of the social and economic forces of the Middle East. The arguments were credible (drawn from the writings of several prominent analysts) and buttressed with factual evidence and historical analysis. By contrast, in a condition where participants selffiaYrmed prior to reading the report (by writing about an important value unrelated to their national identity), patriots became more open to the report, and antifipatriots became more skeptical of it. Indeed, the correlation between prior identity and openness was reduced to nil (r fiA. Collective identity ceased to aVect the assimilation of new information when participants had aYrmed an alternative source of selffiintegrity. Several studies, both in the laboratory and in the field, have now examined whether selffiaYrmation can reduce stereotype threat and facilitate performance in conditions where people from negatively stereotyped groups have been shown to underperform (Spencer, Steele, & Quinn, 1999; Steele & Aronson, 1995). One study examined whether stereotype threat could be reduced among women taking a math test (Martens, Johns, Greenberg, & Schimel, 2006). To the extent that women care about performing well in such a situation, they may worry, should they perform poorly, that they could confirm the nega tive stereotype that women are worse than men at math. If so, then aYrma tion of an alternative aspect of the self could reduce the threat and facilitate performance. Whereas other interventions to reduce stereotype threat directly refute the stereotype or its relevance. Replicating the standard stereotype threat eVect (Steele, Spencer, & Aronson, 2002), women performed worse in the abilityfidiagnostic condition (where they were aware that a potentially poor performance on their part could be viewed as evidence of lack of math ability and as ultimately a validation of the negative stereotype), worse than their female counterparts in the abilityfinondiagnostic condition, and worse than men overall. Given the evidence that selffiaYrmation appears to reduce stereo type threat among students in laboratory situations (Martens et al. In such educa tional contexts, social identity threat may be exacerbated by the mis trust that minority students sometimes feel when confronted with negative or critical feedback from White evaluators and teachers (Cohen et al. Because they know that the stereotype could bias members of the outgroup, these students may come to doubt the intentions motivating critical feedback. To examine this question, a field study (Cohen, Garcia, Apfel, & Masters, 2006) was conducted that featured a randomized, doublefiblind experimental design. Students completed a 20fiminute inficlass selffiaYrmation exercise in which they wrote about an important value and why it mattered to them, or, in a control condition, wrote about an unimportant value and why it might be important to someone else. In the control condition, minority students, unlike their majority peers, displayed a decline in trust in their teachers and school administrators over the course of the 7thfigrade school year. That is, they judged their grades and treatment in school as less fair and more biased at the end of the year than they had at the beginning. By contrast, aYrmed minority students remained constant in their relatively high levels of trust and perceived fairness over the course of the school year (see Fig. Just as aYrmation increases trust across partisan lines in the context of negotiation (Cohen et al. Consider a European American evaluating whether prejudice against minorities still constitutes a major factor in the diVerential academic and economic success of people from diVerent groups. One way people from majority groups can reduce this threat is by minimizing the perceived frequency and impact of prejudice against minority groups. Overall, Latinos perceived more prejudice against minorities in everyday life than did European American participants. Importantly, the eVect of selffiaYrmation was more evident among European Americans than Latino Americans. While Latino Americans showed a slight drop in their percep tion of prejudice against minority groups when selffiaYrmed, this drop was not significant. On the other hand, selffiaYrmation led European Americans to perceive significantly more racism against minorities in the United States (Adams et al. Thus, the otherwise threatening idea of racism in America was more acceptable among those who were buVered by a selffiaYrmation.

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Many patients have a good-to-excellent prognosis following initial All excised tumors should be submitted for histopathologic radiotherapy acne questionnaire order 20gm cleocin gel overnight delivery. The accuracy of margin periodic post-therapy examinations due to the possibility of analyses can be optimized by inking the excised specimen to recurrence skin care products for rosacea buy cleocin gel online pills, metastasis acne 7 year old boy 20gm cleocin gel visa, new tumor development acne 5 purchase 20gm cleocin gel otc, or complications allow the pathologist to distinguish true surgical margins from of initial therapy acne out discount 20 gm cleocin gel. Partial response or labs typically prepare only four or five slides from a given stabilization of the growth of the primary tumor acne with mirena cheap 20gm cleocin gel with mastercard, leaving residual specimen, a report of complete margins does not necessarily disease, may be the maximum post-therapy response seen. Use of the latter two agents is justified by their anti angiogenic properties as well as their anti-proliferative effects. Responses must be viewed in needed at this critical juncture because of the guarded prognosis context with the original intent of therapy, whether it be cure or and likelihood that a return to normalcy may not be possible. The case study is not intended be prescriptive or to imply that the approach taken here is the only way to manage an osteosarcoma patient, nor is it intended to be used as a diagnostic tree. Practitioners interested in oncology are encouraged to research current diagnostics, chemotherapeutics, and modalities appropriate for each cancer patient as the best way of keeping current in this rapidly evolving field of veterinary medicine. Distal limb radiographs revealed an osteolytic and proliferative lesion of the distal carpus (Figure 1). Three view thoracic radiographs revealed no visible lesions and were considered normal. Other diseases on the differential list are a metastatic bone tumor and infectious disease (bacterial, fungal). Three-view thoracic radiographs were performed every 3 mo following completion of chemotherapy. Nine mo after the last chemotherapy treatment, radiographic evidence of metastasis was found. Once metastatic disease becomes clinically apparent, a site reveals a cellular architecture indicative of sarcoma, including realistic goal of therapy is to attempt to stabilize it or slow its indistinct cytoplasmic borders and atypical nuclei. Decision point rationale: If a referral is made, follow-up care by Three mo later, three-view thoracic radiographs revealed that the primary care veterinarian is appropriate. Bo important that the primary and referral veterinarians discuss continued to maintain a good quality of life for 6 mo until he postoperative care, follow-up blood work, and management of any eventually became dyspneic. A complete blood count, comprehensive chemistry profile, Patients, Pet Owners, and the Environment and a urinalysis were performed to rule out comorbidities. Results of the blood work and and Health Administration investigation, fines, and lawsuits. Ideally, gloves should be powder free and breast feeding, should avoid working with chemotherapy rated for chemotherapy use by the American Society for Testing agents. These Australian shepherd 50% Australian shepherd mini 50% are easily confused and can lead to drastically different dose Border collie,5% calculations. Prior to mixing chemotherapy drugs, calculations Collie 70% should be done by two individuals. The two calculated doses can English shepherd 15% then be compared and serve as a double check. Extravasation Potential of Chemotherapeutic Agents A trained and experienced staff will greatly decrease procedure-related extravasation risk factors. Rather, attempt to aspirate as much drug as possible and do vinblastine, are substrates for p-glycoprotein (Pgp) pumps and 34 not inject any fluid into the catheter. Because heparin can cause precipitation or inactivation of Diluted drugs should be labeled with the amount of drug in some chemotherapy agents, non-heparinized flushes are recom milligrams contained in the syringe or minibag. The Institute for Safe Medical Practices has developed several Extravasations strategies to prevent simple errors. This type of acceptance Good communication skills are a key component of a successful 39 will help the owner of a cancer patient to be open and express practice. Oncology cases raise the bar by placing a premium on the difficult or even embarrassing issues and questions. Practitioners should be mindful of their own nonverbal thoughts about the options we have discussedfi This technique is a good way as individuals with feelings and emotions, and not just as a customer. Reflective statements not only the ability to express empathy improves with practice. Experts agree that the opposite operate as a kind of check step in how you perceive the case and usually occurs. Together, the healthcare team can Breaking the News make decisions and implement a treatment plan that proves Clients need time to adjust to the idea that their pet may have satisfactory for all concerned. Many practices now have a designated room that provides uncommon for an initial refusal to consider more testing or privacy and a non-clinical, stress-free atmosphere for the euthanasia treatment to change with further discussion about how well most procedure. A bereavement counselor and support groups can be great pets do with their therapy. A Practice Team practitioner who takes that approach almost always helps the pet It is important to enlist the skills and resources of the entire owner transition from shock and sadness over a cancer diagnosis to healthcare team when caring for an oncology patient. Balancing realism with the roles and responsibilities of each staff member involved in an optimism is critical for veterinarians treating cancer. In particular, staff training is most effective Cancer treatment is case specific and multifactorial. An expectation that all staff critical factor in deciding which treatment modalities to use, or members will effectively contribute to oncology case management whether to treat the disease at all or to instead rely on palliative is not realistic unless they have been trained to do so. Chemotherapy, immunotherapy, adjunctive therapies, should assess their training programs to ensure that the unique radiotherapy, and surgery can be used individually or in tandem requirements of oncology treatment are specifically addressed. Chemotherapy is now commonly used in veterinary healthcare team to implement clinical protocols are provided in oncology. However, the inherent toxicity of chemotherapy agents recently published feline healthcare guidelines. Antitumor effects of deracoxib on tissues highly sensitive to the toxic effects of maximum tolerated dose treatment in 26 dogs with transitional cell carcinoma of the urinary regimens. Vet Clin North Am Antineoplastic and Other Hazardous Drugs in Healthcare Settings. College of Veterinary Medicine, Veterinary Clinical effects of toceranib combined with low-dose cyclophosphamide in dogs Pharmacology Laboratory, Washington State University. College Of Veterinary Medicine, Veterinary Clinical of delayed vomiting associated with administraiton of doxorubicin to Pharmacology Laboratory, Washington State University. Effectiveness and Safety of Autologous Fat Transfer in Various Treatment Protocols. There can be important differences between the submitted version and the official published version of record. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. Letschert in accordance with the decision of the Board of Deans, to be defended in public th on Thursday the 12 of April 2018, at 16. Plastic and Reconstructive Surgery 2016 Jan;137(1):31e-43e Chapter 5 Autologous Fat Grafting: A Promising Technique with Various Indications. Plastic and Reconstructive Surgery Global Open, 2017; 5:e1606, Published online 22 December 2017. Chapter 10 General Discussion 227 Chapter 11 253 Valorization addendum 255 Summary 261 Nederlandse samenvatting 265 Acknowledgements (dankwoord) 269 List of publications 273 About the author 275 8 Chapter 1 General Introduction 9 General Introduction Prelude the nomenclature surrounding the technique of the reinjection of autologous fat has evolved parallel to its many other aspects during the formation of this dissertation. Breast cancer and reconstructive options 1,2 Breast cancer is still the most common cancer in women in Europe and 3 worldwide with over nearly 1. Ongoing developments in early screening as well as better and more 5 targeted therapies have dramatically improved the survival rate with 5 and 10 6 year survival rates following diagnosis being 87% and 82% respectively. One of the important distinctions that has to be made early in the diagnosis, for the treatment/survival as well as the reconstructive options, is the extension and the type of tumor. The two most common types of breast cancer are the ductal (originating from the epithelial cells of the milk ducts) and lobular (originating from mammary glandular tissue) carcinomas which can be contained to a local cluster of precancerous cells (carcinoma in situ or cis) or invasive in relation to adjacent tissues. Of the invasive or infiltrating type, ductal carcinoma comprises 7 70% to 80% compared to approximately 8% lobular carcinoma. The most important goal in treating a patient with newly diagnosed breast can cer is survival. Over the last decades smaller, less mutilating forms of breast cancer surgery have been developed that achieve the same survival rates as the rigor ous radical mastectomies of the previous century. While all these techniques can achieve excellent cosmetic results, they are not flawless or without (sometimes disastrous) complications. This was followed by the 1950s and 1960s when augmentation was car ried out with solid alloplastic materials like, amongst others, polyurethane. Be cause of the significant complications, this technique was abandoned and re placed by the direct intra-parenchymal injection of semi-solid materials like beeswax, paraffin and even silicone itself before again being abandoned be 19-21 cause of complications. Both implants share a silicone sheath, which, as part of the fifth generation, currently is being offered in a wide 23 variety of sizes and shapes. Mul 25-31 tiple clinical studies as well as a meta-analysis combining data from over 87 32 000 women has shown no correlation between breast implants and auto immune or connective tissue disease. With these new developments and the steady growth of wom 35 en seeking breast augmentation (290. Scars Besides the mutilating effects of breast cancer surgery, the sequelae of scars in general, regardless of the location or etiology can be equally emotional for pa 36 tients. Even though for physicians a scar, especially a matured scar signifies the endpoint of tissue healing, for patients its meaning can have pronounced implications for multiple aspects of daily live and, in addition, can be anchored on a psychological, social or even cultural level. The prevention and treatment of scars is a well-covered subject in present day education in plastic surgery. Soft-tissue fillers and facelifting are amongst the oldest known techniques used to alter the facial 42 appearance, with Robert Gersuny injecting vaseline in 1899 and Hollander 43 performing the self-proclaimed first facelift in 1901. Currently, there seems to be a shift towards the use of dermal fillers at the ex pense of surgical procedures like the facelift, which saw a 17% decrease since the beginning of the new millennium. On the other hand it might also represent the way our concepts of how the face changes with time, is evolving. The loss of elasticity that causes sagging of the skin was traditionally treated with resuspension and removal of excess (dermal) tissue. It was Eugene Hollander who, in 1909, suggested the idea of injecting fat through a cannula and both 14 General Introduction 50 51 Erich Lexer and Charles Miller further elaborated on the idea by describing its use for different conditions. In clinical practice the choice of harvest-location is generally based on the de sires of the patient and the accessibility of the fat. Several studies have indicated 61 superiority of one harvest location over the other with Jurgens et al.

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