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BACKGROUND Breast trauma can always have diagnostic pitfalls. In the presence of a recurrent hemorrhagic cysts, cancer should always be suspected. CASE REPORT A 59-year-old woman noted a palpable mass after breast trauma from falling at home. Radiological exams showed a breast cyst with well-defined margins, with corpuscular and dense fluid components. First, a conservative approach was implemented. One week later, a fine-needle aspiration cytology (FNAC) of the mass showed bloody fluid without atypical cells. Three weeks later, the patient was emergently evaluated due to increased size of the lesion and anemia. To avoid further blood loss and due to suspected malignancy, an urgent surgical excision biopsy was planned. Histopathology revealed a poorly-differentiated carcinoma and the patient was treated with left modified radical mastectomy with axillary dissection. Adjuvant chemotherapy was administered. At 6-month follow-up, the patient was free from recurrences. CONCLUSIONS Recurrent hemorrhagic cysts should always be investigated and considered as a possible cancer lesion. Sonography and cytological exam are the first steps in case of suspicious cysts, but false-negative results are common. In such cases, resection of the cyst should be considered. Immediate resection is valid in cases of diagnostic uncertainty or inability to assess the cyst with imaging or biopsy.

Background/aim: Extraordinary restrictions aimed to limit Sars-CoV-2 spreading; they imposed a total reorganization of the health-system. Oncological treatments experienced a significant slowdown. The aim of our multicentric retrospective study was to evaluate screening suspension and surgical treatment delay during COVID-19 and the impact on breast cancer presentation., Patients and Methods: All patients who underwent breast surgery from March 11, 2020 to May 30, 2020 were evaluated and considered as the Lockdown group. These patients were compared with similar patients of the previous year, the Pre-Lockdown group., Results: A total of 432 patients were evaluated; n=223 and n=209 in the Lockdown and Pre-lockdown-groups, respectively. At univariate analysis, waiting times, lymph-nodes involvement and cancer grading, showed a statistically significant difference (p<0.05). Multivariate analysis identified waiting-time on list (OR=1.07) as a statistically significant predictive factor of lymph node involvement., Conclusion: Although we did not observe a clinically evident difference in breast cancer presentation, we reported an increase in lymph node involvement., (Copyright © 2020 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses., Patients and Methods: Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed., Results: During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005)., Conclusion: We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19., Patients and Methods: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason., Results: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients., Conclusion: COVID-19-related anxiety could affect patients' decision-making process., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aims: To evaluate the role of achieving immediate target angles on the success of strabismus surgery., Methods: We performed a retrospective cohort study of all patients over 12 years old undergoing strabismus surgery with either adjustable or non-adjustable sutures. Target angle for patients with esotropia and vertical deviation was within 4 prism dioptres (PD) of orthotropia and for patients with exotropia between orthotropia and 8 PD of esotropia. Success was defined as alignment within 10 PD for horizontal rectus surgery and within 5 PD of orthotropia for vertical rectus surgery, without diplopia or reoperations. The main outcome measure was surgical success rate., Results: Three hundred and fifty-three patients were included in the study with mean follow-up of 13.9 (4-132) months. Patients achieving the target angle immediately postoperatively had higher success rate than patients who did not (83.6% vs 63.7%, p<0.0001, OR 2.9, 95% CI 1.8 to 4.9). When target angle was achieved, adjustable and non-adjustable sutures had similar success (84.8% and 80.9%, respectively, p=0.46, OR 1.3, CI 0.58 to 2.9). However, patients undergoing adjustable surgery were more likely to obtain the target angle (75.5% vs 54%, p<0.0001, OR 2.7, CI 1.7 to 4.2). Success for exotropia surgery was significantly higher when the immediate target angle was achieved (86.4% vs 58.7%, p<0.0001, OR 4.47, CI 2.3 to 8.6). For esotropia and vertical deviations, a similar beneficial effect was not shown (p=0.31, OR 1.6, CI 0.65 to 4.0 and p=0.33, respectively). On multiple logistic regressions, sex, amblyopia, binocularity and reoperations were not significant factors in surgical success., Conclusions: Our results suggest that achieving the immediate target angle is the most significant factor in the success of strabismus surgery for exotropia. Adjustable suture surgery results in higher proportion of patients achieving this target angle., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: To determine if achieving the ideal postoperative target range increases the long-term success of pediatric strabismus surgery., Design: Interventional case series., Methods: Children below 12 years old with horizontal strabismus who underwent surgical correction by recession, resection, advancement, or a combination of both between 1996 and 2011 were included. Alignment was measured within 1 week and at a minimum of 6 months after surgery. The ideal postoperative target range was defined as 0-8 prism diopters (PD) of esotropia in exotropic patients and within 4 PD of orthotropia in esotropic patients measured within 1 week after the surgery. Success was defined as a measurement within 10 PD of orthotropia at the latest postoperative visit. The main outcome measures were surgical success rate and the factors affecting it., Results: We included 352 patients with mean follow-up of 18 months. Overall, patients within the target range had a higher success rate than those outside it (75.6% vs 57% P = .0004). This was highly significant for exotropia (P = .0002) but not for esotropia (P = .4). Multiple regression analysis revealed that being within target range was the strongest predictor of long-term success (odds ratio [OR] = 2.3, range 1.4-3.7). Overall, surgeries on patients with esotropia were more likely to be successful than on those with exotropia (OR = 1.9, range 1.2-3), and premature patients had poorer outcomes (OR = 0.2, range 0.1-0.8)., Conclusion: Achieving the ideal target range within 1 week after surgery is associated with a high rate of long-term success in exotropia surgery in children., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the success of adjustable suture (AS) and nonadjustable suture (NAS) strabismus surgery in primary procedures and reoperations., Design: Retrospective case series., Participants: Four hundred four patients older than 12 years who underwent strabismus surgery over a 13-year period., Methods: All eyes underwent the same hang-back suturing technique by a single surgeon (S.P.K.) in both the AS and NAS groups. Success was defined as alignment within 10 prism diopters (PD) for horizontal recti and within 5 PD of orthophoria for vertical recti without diplopia or further surgery., Main Outcome Measures: Surgical success rate of AS and NAS primary surgery or reoperations was the primary outcome measure. Effects of amblyopia, binocularity, and strabismus type on success were secondary outcome measures and were analyzed using multiple logistic regression., Results: Patients in the AS group required adjustment in 28.8% of cases. Higher overall success was seen with AS (77.7%) compared with NAS (69.1%) surgery, although this did not reach significance (P = 0.059). Overall success for AS in exotropia surgery (80.8%) was significantly higher than that in the NAS group (65.9%; P = 0.011). This was because of higher success in patients undergoing primary surgery (82.5% vs. 50%; P = 0.003), but not in patients undergoing reoperation (80.2% vs. 77.6%; P = 0.71). On multiple regression analysis, male gender and not having a mechanical or neurogenic cause for strabismus were significant factors for a successful outcome. Overall, other factors including amblyopia, binocularity, strabismus type, and primary or reoperation were not significant., Conclusions: These results suggest that primary surgery in adults with exotropia has a more successful outcome with AS surgery. This advantage was not present with esotropia and vertical deviations in this series., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)