Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Kidney Stones and Hyperparathyroidism

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉Patients with hyperparathyroidism may develop kidney stones or nephrocalcinosis (deposition of calcium salts in the renal parenchyma).

👉Kidney stones may be symptomatic (10% to 20% of patients) or silent and seen only on imaging tests.

👉Read more at https://collectedmed.com/index.php/article/article/demo_article_display/7546/83/1/1

#Arrangoiz

#ParathyroidExpert #ParathyroidSurgeon

Blood Supply of the Pancreas

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉The pancreas derives a rich blood supply from both celiac axis and superior mesenteric artery, with collaterals between the two systems; that is why when angiography is done for bleeding as a complication of acute pancreatitis, chronic pancreatitis or pancreatoduodenectomy both celiac axis and superior mesenteric artery should be evaluated.

#Arrangoiz #Teacher #Surgeon

Guidelines for screening of breast cancer in patients with mutations

Rodrigo Arrangoiz MS, MD, FACS, FSSO

BRCA1/BRCA2:
👉Age 25 to 29 – Annual breast MRI with contrast (or mammogram preferably with tomosynthesis if MRI is unavailable)
👉Age 35 to 75 – Annual mammogram preferably with tomosynthesis and breast MRI with contrast
👉Age > 75 – Management should be considered on an individual basis

TP53:
👉20 to 29 – Annual breast MRI with contrast 👉30 to 75 – Annual mammogram preferably with tomosynthesis and breast MRI with contrast
👉Age > 75 – Management should be considered on an individual basis

ATM:
👉Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 40 y

CDH1:
👉Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 30 y

CHEK2:
👉Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 40 y

NBN:
👉Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 40 y

NF1:
👉Annual mammogram with consideration of tomosynthesis at age 30 y and consider breast MRI with contrast from age 30 to 50 y

PALB2:
👉Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 30 y

PTEN:
Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 30 to 35 y or 5 to 10 yrs before earliest family breast cancer

STK11:
👉Annual mammogram with consideration of tomosynthesis and consider breast MRI with contrast at age 25 y

#Arrangoiz #BreastSurgeon #BreastCancer

Sensory Innervation of the Ear

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The innervation to the ear is one of the most complex in the body:
    • There are four cranial nerves and two upper cervical nerves that contribute to sensory innervation of the ear:
      • Cranial nerves:
        • V
        • VII
        • IX
        • X
      • Upper cervical nerves:
        • C2
        • C3
          • Though the sensory innervation to the ear may appear fairly well defined:
            • There is considerable overlap and ambiguity in the sensory distribution of these nerves

Essentially any pathology residing within the sensory net of cranial nerves V, VII, IX, and X and upper cervical nerves C2 and C3 can potentially cause pain referred to the ear
  • The mandibular division of CN V (V3):
    • Supplies the:
      • Tragus
      • Helical crus
      • Anterosuperior wall of the external auditory canal
      • Adjacent tympanic membrane
      • Temporomandibular joint
    • The auriculotemporal branch but also has sensory nerve fibers via the lingual, buccal, and inferior alveolar nerves:
      • Which serve to innervate the:
        • Oral cavity:
          • Floor of mouth, lower teeth, palate, mandible including the temporomandibular joint (TMJ)
        • The three mayor salivary glands

Primary and referred otalgia pathways of the mandibular nerve (V3). Cranial nerve V is the most frequent pathway for referred otalgia via the auriculotemporal branch (Nerve of Arnold) of the trigeminal nerve.
  • The facial nerve (VII) supplies the:
    • Posterior-inferior portion of the external ear canal
    • Adjacent tympanic membrane
      • The sensory distribution of the facial nerve is variable:
        • With an overlapping sensory distribution with the trigeminal nerve
      •  The seventh cranial nerve:
        • The posterior auricular nerve:
          • Serves to innervate the ear directly
        • The greater superficial petrosal nerve and the vidian nerve serve to supply the:
          • Nasal mucosa
          • Posterior ethmoid
          • Sphenoid sinuses
          • Soft palate

Primary and referred otalgia pathways of the facial nerve (VII). Cranial nerve VII produces referred otalgia via the auricular branch of the facial nerve. Bell palsy can present as ear pain, antecedent to facial paralysis.
  • The glossopharyngeal nerve (IX) supplies the:
    • Inner ear
    • Inner tympanic membrane
      • The tympanic nerve (Jacobson nerve, a branch of cranial nerve IX):
        • Directly innervates the ear but also has:
          • Pharyngeal, lingual, and tonsillar branches to supply the:
            • Posterior one-third portion of the tongue
            • Tonsillar fossa / pillars
            • Pharynx:
              • Inferior nasopharynx
            • Parapharyngeal space
            • Retropharyngeal space
            • Eustachian tube

Cranial nerve IX mediates otalgia via the tympanic nerve of Jacobson
  • The vagus nerve (X) supplies:
    • A similar distribution to CN IX:
      • But also innervates the concha
    • The vagus nerve supplies the:
      • Valleculae
      • Lingual, and laryngeal surfaces of the epiglottis
      • Supraglottic larynx
      • Pyriform sinuses
      • Thyroid gland
      • More distant sites within the thorax:
        • Including the tracheobronchial tree and esophagus
    • The Arnold nerve:
      • Directly innervates the ear
    • The internal branch of the superior laryngeal nerve:
      • Innervate the larynx
    • The pharyngeal branch of the vagus nerve:
      • Innervate the lower pharynx

Primary and referred otalgia pathways of the vagus nerve (X). Cranial nerve X is involved with otalgia via the auricular nerve of Arnold.
  • The upper cervical nerves (C2 and C3) innervate:
    • The skin in front of and behind the ear
    • The medial and lateral aspect of the auricle
    • Temporomadibular joint
      • The upper cervical nerves (C2 and C3) innervate a significant portion of the external ear, including the auricle, lobule, and the skin in front of and behind the external ear via the:
        • Great auricular nerve
        • Lesser occipital nerves

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

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  • Rodrigo Arrangoiz MS, MD, FACS:
    • Is a member of the American Head and Neck Society

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    • He is a member of the American Thyroid Association:

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Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Teacher

#Surgeon

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#CirujanodeTumoresdeCabezayCuello

#OralCavityCancer

#Melanoma

Breast Cancer Genetics

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉Lifetime breast cancer risk is only 13% for identical twins of breast cancer patients compared to 9% for dizygotic twins.

👉Twin studies are important because they help us understand how far genetics will get us as we try to risk stratify populations.

👉Other twin studies have estimated that 12% to 30% of breast cancer is primarily genetic in origin.

👉Thus, only a minority of breast cancers are directly attributed to germline genetics and only 5% to 10% are thought to be due to inheritance of mutations in major autosomal dominant breast cancer predisposition genes.

👉REFERENCES

  1. Baker SG, Lichtenstein P, Kaprio J, et al. Genetic susceptibility to prostate, breast, and colorectal cancer among Nordic twins. Biometrics. 2005;61:55-63.
  2. Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer–analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med. 2000;343:78-85.
  3. Locatelli I, Lichtenstein P, Yashin AI. The heritability of breast cancer: a Bayesian correlated frailty model applied to Swedish twins data. Twin Res. 2004;7:182-191.

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

Osteitis Fibrosa Cystica in Hyperparathyroidism

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉An extreme form of parathyroid bone disease termed osteitis fibrosa cystica is characterised by significant loss of bone density, development of bone cysts and brown tumors (shown below), skeletal deformity, bone pain, and a propensity for pathologic fractures.

👉Fortunately, it is quite rarely seen these days.

👉Read more about the signs and symptoms of parathyroid disease at https://collectedmed.com/index.php/article/article/demo_article_display/7546/83/1/1

#Arrangoiz

#ParathyroidSurgeon

#ParathyroidExpert

#HeadandNeckSurgeon

#Teacher

Are Prophylactic Antibiotics Required Before Breast Surgery? Even if it is a Clean Case?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
👉The use of prophylactic antibiotics depends on:

  • The type of case (clean vs contaminated)
  • As well as patient specific variables such as the presence of a mechanical heart valve or other prosthesis, placement of a prosthesis, such as a tissue expander, and/or other variables.
  • 👉Prolonged prophylactic antibiotics are avoided due to concerns over promoting the incidence of multidrug resistant bacterial infections and because the risks of this strategy outweigh the benefits in reducing postoperative infections.
  • 👉Strong evidence supports a single dose of prophylactic antibiotics prior to breast surgery.
  • 👉There is no evidence that antibiotics improve wound healing aside from decreasing infection rates.
  • 👉There does not appear to be benefit from additional postoperative antibiotics.
  • 👉Patients undergoing re-excision lumpectomy appear to be at increased risk of infection and would also benefit from prophylactic antibiotics. 

    • REFERENCES

    1. The American Society of Breast Surgeons. Surgical site infection and cellulitis after breast and/or axillary surgery.Accessed January 18, 2017
    2. Hall JC, Willsher PC, Hall JL. Randomized clinical trial of single-dose antibiotic prophylaxis for non-reconstructive breast surgery. Br J Surg. 2006;93:1342-1346.
    3. Jones DJ, Bunn F, Bell-Syer SV. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2014;3:CD005360.
    4. Kataria K, Bagdia A, Srivastava A, et al. Are breast surgical operations clean or clean contaminated? Indian J Surg. 2015;77:S1360-S1362. 
    5. Throckmorton AD, Hoskin T, Boostrom SY, et al. Complications associated with postoperative antibiotic prophylaxis after breast surgery. Am J Surg 2009;198:553-556.
    6. Tran CL, Langer S, Broderick-Villa G, et al. Does reoperation predispose to postoperative wound infection in women undergoing operation for breast cancer? Am Surg. 2003;69:852-856.

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

    • Es experto en el manejo del cáncer de mama.

     

    👉Es miembro de la American Society of Breast Surgeons:

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

     

    #Arrangoiz

    #Surgeon

    #Cirujano

    #SurgicalOncologist

    #CirujanoOncologo

    #BreastSurgeon

    #CirujanodeMama

    #CancerSurgeon

    #CirujanodeCancer

    The most appropriate posttherapy breast imaging surveillance after Breast Conservation Surgery is?

    Rodrigo Arrangoiz MS, MD, FACS, FSSO
    👉Women with a personal history of breast cancer are at an elevated lifetime risk of developing an ipsilateral breast tumor recurrence (IBTR) or a new primary cancer in the contralateral breast.
    👉Women with early-stage invasive breast cancer treated with breast-conserving therapy are reported to develop IBTR at a rate of approximately 0.5 to 1.0%/year.
    👉There are no randomized controlled trials reporting the accuracy or impact on breast cancer mortality of mammographic surveillance following breast cancer treatment.
    👉The sensitivity of screening mammography to detect IBTR ranges from 50% to 80% and to detect contralateral breast cancer, from 45% to 90%.
    👉Surveillance for breast cancer survivors is not a generally recognized indication for breast MRI.
    👉In fact, the most recent 2012 American Society of Clinical Oncology (ASCO) Guidelines advise against breast MRI for routine breast cancer surveillance:

    • Instead advocate that the first postlumpectomy mammogram be done at least 6 months after completing radiation therapy, with subsequent mammograms obtained yearly thereafter.
    • Current National Comprehensive Cancer Network guidelines mirror the ASCO guidelines. 

    REFERENCES

    1. Houssami N, Ciatto S. Mammographic surveillance in women with a personal history of breast cancer: how accurate? how effective? Breast. 2010;19:439-445.
    2. Khatcheressian JL, Hurley P, Bantug E, et al; American Society of Clinical Oncology. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:961-965.
    3. Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010;375:563-571.

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

    • Es experto en el manejo del cáncer de mama.

     

    👉Es miembro de la American Society of Breast Surgeons:

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

     

    #Arrangoiz

    #Surgeon

    #Cirujano

    #SurgicalOncologist

    #CirujanoOncologo

    #BreastSurgeon

    #CirujanodeMama

    #CancerSurgeon

    #CirujanodeCancer

    What is the best imaging modality to determine imaging response to neoadjuvant therapy in breast cancer?

    Rodrigo Arrangoiz MS, MD, FACS, FSSO
    👉Breast MRI is the most sensitive and specific imaging modality to determine imaging response to neoadjuvant therapy and has the highest correlation coefficient when comparing imaging size to pathologic tumor size when compared to any combination of physical examination, mammography, and ultrasonography.
    👉Nevertheless, it is not necessary to routinely perform post-treatment MRI, especially when a well-circumscribed sonographically visible cancer has been followed with ultrasound during treatment.
    👉Researchers are studying breast specific gama imaging (BSGI) as an enhanced screening modality but its accuracy in determining tumor detection and response after neoadjuvant therapy is unproven. The high dose of radiation with BSGI has been a concern. 

    👉REFERENCES

    1. De Los Santos JF, Cantor A, Amos KD, et al. Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer (TBCRC 017). Cancer. 2013;199:1776-1783.
    2. Lee HS, Ko BS, Ahn SH, et al. Diagnostic performance of breast-specific gamma imaging in the assessment of residual tumor after neoadjuvant therapy in breast cancer patients. Breast Cancer Res Treat. 2014;145:91-100.
    3. Marinovich ML, Macaskill P, Irwig L, et al. Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy. Br J Cancer. 2013; 109:1528-1536.
    4. McLaughlin S, Mittendorf EA, Bleicher RJ, et al. The 2013 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: MRI in breast cancer: where are we now? Ann Surg Oncol. 2014;21:28-36.

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

    • Es experto en el manejo del cáncer de mama.

     

    👉Es miembro de la American Society of Breast Surgeons:

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

     

    #Arrangoiz

    #Surgeon

    #Cirujano

    #SurgicalOncologist

    #CirujanoOncologo

    #BreastSurgeon

    #CirujanodeMama

    #CancerSurgeon

    #CirujanodeCancer