Radical Mastectomy
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Radical Mastectomy
Radical mastectomy is a surgical procedure involving the removal of breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla as a treatment for breast cancer. Breast cancer is the most common cancer among women today, and is primarily treated by surgery, particularly during the early twentieth century when the mastectomy was developed with success. However, with the advancement of technology and surgical skills, the extent of mastectomies has been reduced. Less invasive mastectomies are employed today in comparison to those in the past. Nowadays, a combination of radiotherapy and breast conserving mastectomy are employed to optimize treatment. Radical mastectomy Halsted and Meyer were the first to achieve successful results with the radical mastectomy, thus ushering in the modern era of surgical treatment for breast cancer. In 1894, William Halsted published his work with radical mastectomy from the 50 cases operat ...
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Pectoralis Major
The pectoralis major () is a thick, fan-shaped or triangular convergent muscle, situated at the chest of the human body. It makes up the bulk of the chest muscles and lies under the breast. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. The pectoralis major's primary functions are flexion, adduction, and internal rotation of the humerus. The pectoral major may colloquially be referred to as "pecs", "pectoral muscle", or "chest muscle", because it is the largest and most superficial muscle in the chest area. Structure It arises from the anterior surface of the sternal half of the clavicle from breadth of the half of the anterior surface of the sternum, as low down as the attachment of the cartilage of the sixth or seventh rib; from the cartilages of all the true ribs, with the exception, frequently, of the first or seventh, and from the aponeurosis of the abdominal external oblique muscle. From this extensive origin the fibers converge towa ...
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Granulation Tissue
Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size. Examples of granulation tissue can be seen in pyogenic granulomas and pulp polyps. Its histological appearance is characterized by proliferation of fibroblasts and new thin-walled, delicate capillaries (angiogenesis), infiltrated inflammatory cells in a loose extracellular matrix. Appearance During the migratory phase of wound healing, granulation tissue is: * light red or dark pink, being perfused with new capillary loops or "buds"; * soft to the touch; * moist; * bumpy (granular) in appearance, due to punctate hemorrhages; * pulsatile on palpation; * painless when healthy; Structure Granulation tissue is composed of tissue matrix supporting a variety of cell types, most of which can be associated with one of the following function ...
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Breast Surgery
Breast surgery is a form of surgery performed on the breast. Types Types include: *Breast reduction surgery *Augmentation mammoplasty * Mastectomy *Lumpectomy *Breast-conserving surgery, a less radical cancer surgery than mastectomy *Mastopexy, or breast lift surgery * Surgery for breast abscess, including incision and drainage as well as excision of lactiferous ducts * Surgical breast biopsy * Microdochectomy (removal of a lactiferous duct) Complications After surgical intervention to the breast, complications may arise related to wound healing. As in other types of surgery, hematoma (post-operative bleeding), seroma (fluid accumulation), or incision-site breakdown (wound infection) may occur. Breast hematoma due to an operation will normally resolve with time but should be followed up with more detailed evaluation if it does not. Breast abscess can occur as post-surgical complication, for example after cancer treatment or reduction mammaplasty.Noel Weidner, Chapter ''Inf ...
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Sampson Handley
William Sampson Handley MD, MS, FRCS (12 April 1872 – 1962) was an English surgeon who influenced the development of cancer surgery. He was born in Loughborough, Leicestershire, England, he was the son of a Chemist Thomas Handley. He was educated at Loughborough Grammar School. Sampson Handley trained as a medical doctor at Guy's Hospital from 1889 where he qualified in 1895 and became an MD the following year. He took in an interest in pathology as a route to becoming a surgeon and became a Fellow of the Royal College of Surgeons in 1897. He worked at the cancer research wing at the Middlesex Hospital where he researched the methods by which cancer spread. He found that the main extension of breast cancer was along the lymphatics and he coined the words ''Lymphatic permeation''. In 1905 he became an Assistant Surgeon at the Middlesex Hospital and continued his research into cancer. In 1906 he published ''Cancer of the Breast and its Operative Treatment'' which created hi ...
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Lymph Duct
A lymph duct is a great lymphatic vessel that empties lymph into one of the subclavian veins. There are two lymph ducts in the body—the right lymphatic duct and the thoracic duct. The right lymphatic duct drains lymph from the right upper limb, right side of thorax and right halves of head and neck. The thoracic duct drains lymph into the circulatory system at the left brachiocephalic vein between the left subclavian and left internal jugular veins. See also * Lymphatic system * Right lymphatic duct * Thoracic duct In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. It is also known as the ''left lymphatic duct'', ''alimentary duct'', ''chyliferous duct'', and ''Van Hoorne's canal''. The other duct is the rig ... References Lymphatic system {{lymphatic-stub ...
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Bernard Fisher (scientist)
Bernard Fisher (August 23, 1918 – October 16, 2019) was an American surgeon and a pioneer in the biology and treatment of breast cancer. He was a native of Pittsburgh. He was Chairman of the National Surgical Adjuvant Breast Project at the University of Pittsburgh School of Medicine. His work established definitively that early-stage breast cancer could be more effectively treated by lumpectomy, in combination with radiation therapy, chemotherapy, and/or hormonal therapy, than by radical mastectomy. The oncology journal and website ''OncLive'' described Fisher's research as "launching the breast cancer community into the modern era" and honored him with a Giants of Cancer Care award for his work that ultimately ended the standard practice of performing the Halsted radical mastectomy, a treatment that had been in place for more than 75 years. Thanks to Fisher, notes another major oncology journal, breast-cancer survival rates have improved worldwide. Fisher faced constant attac ...
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Sequela
A sequela (, ; usually used in the plural, sequelae ) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Derived from the Latin word, meaning “sequel”, it is used in the medical field to mean a complication or condition following a prior illness or disease. A typical sequela is a chronic complication of an acute condition—in other words, a long-term effect of a temporary disease or injury—which follows immediately from the condition. Sequelae differ from late effects, which can appear long after—even several decades after—the original condition has resolved. In general, non-medical usage, the terms ''sequela'' and ''sequelae'' mean consequence and consequences. Examples and uses Chronic kidney disease, for example, is sometimes a sequela of diabetes; "chronic constipation" or more accurately "obstipation" (that is, inability to pass stool or gas) is a sequela to an intestinal obstruction; and neck pain is a common sequela of ...
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Lymphedema
Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fluid to the bloodstream. Lymphedema is most frequently a complication of cancer treatment or parasitic infections, but it can also be seen in a number of genetic disorders. Though incurable and progressive, a number of treatments may improve symptoms. Tissues with lymphedema are at high risk of infection because the lymphatic system has been compromised. While there is no cure, treatment may improve outcomes. This commonly include compression therapy, good skin care, exercise, and manual lymphatic drainage (MLD), which together are known as combined decongestive therapy. Diuretics are not useful. Signs and symptoms The most common manifestation of lymphedema is soft tissue swelling, edema. As the disorder progresses, worsening edema a ...
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Perioperative Mortality
Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these. Intraoperative causes Immediate complications during the surgical procedure, e.g. bleeding or perforation of organs may have lethal sequelae. Complications following surgery Infection Countries with a low human development index (HDI) carry a disproportionately greater burden of surgical site infections (SSI) than countries with a middle or high HDI and might have higher rates of antibi ...
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Pectoralis Minor
Pectoralis minor muscle () is a thin, triangular muscle, situated at the upper part of the chest, beneath the pectoralis major in the human body. Structure Attachments Pectoralis minor muscle arises from the upper margins and outer surfaces of the third, fourth, and fifth ribs, near their costal cartilages and from the aponeuroses covering the intercostalis. The fibers pass superior and lateral and converge to form a flat tendon. This tendon inserts onto the medial border and upper surface of the coracoid process of the scapula. Relations Pectoralis minor muscle forms part of the anterior wall of the axilla. It is covered anteriorly (superficially) by the clavipectoral fascia. The medial pectoral nerve pierces the pectoralis minor and the clavipectoral fascia. In attaching to the coracoid process, the pectoralis minor forms a 'bridge' - structures passing into the upper limb from the thorax will pass directly underneath.http://www.teachmeanatomy.com/muscles-of-the-pecto ...
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Pectoralis Major
The pectoralis major () is a thick, fan-shaped or triangular convergent muscle, situated at the chest of the human body. It makes up the bulk of the chest muscles and lies under the breast. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. The pectoralis major's primary functions are flexion, adduction, and internal rotation of the humerus. The pectoral major may colloquially be referred to as "pecs", "pectoral muscle", or "chest muscle", because it is the largest and most superficial muscle in the chest area. Structure It arises from the anterior surface of the sternal half of the clavicle from breadth of the half of the anterior surface of the sternum, as low down as the attachment of the cartilage of the sixth or seventh rib; from the cartilages of all the true ribs, with the exception, frequently, of the first or seventh, and from the aponeurosis of the abdominal external oblique muscle. From this extensive origin the fibers converge towa ...
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William Stewart Halsted
William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922) was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer. Along with William Osler (Professor of Medicine), Howard Atwood Kelly (Professor of Gynecology) and William H. Welch (Professor of Pathology), Halsted was one of the "Big Four" founding professors at the Johns Hopkins Hospital. His operating room at Johns Hopkins Hospital is in Ward G, and was described as a small room where medical discoveries and miracles took place. According to an intern who once worked in Halsted's operating room, Halsted had unique techniques, operated on the patients with great confidence and often had perfect results which astonished the interns. Throughout his professional life, he was addicted to cocaine and later also to morphine, which were ...
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