Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: randomized controlled trial (BREAST-MRI trial).

BACKGROUND: Breast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. Controversy remains about its impact on the preoperative staging of breast cancer surgery. This study evaluated survival and surgical outcomes of preoperative MRI in conservative breast cancer surgery. METHODS: A phase III, randomized, open-label, single-center trial including female breast cancer participants, stage 0-III disease, and eligible for breast-conserving surgery. We compared the role of including MRI in preoperative evaluation versus radiologic exam routine with mammography and ultrasound in breast cancer conservative candidates. The primary outcome was local relapse-free survival (LRFS), and secondary outcomes were overall survival (OS), mastectomy rate, and reoperation rate. RESULTS: 524 were randomized to preoperative MRI group (n = 257) or control group (n = 267). The survival analysis showed a 5.9-years LRFS of 99.2% in MRI group versus 98.9% in control group (HR = 0.72; 95% CI 0.12-4.28; p = 0.7) and an OS of 95.3% in the MRI group versus 96.3% in the control group (HR = 1.37 95% CI 0.59-3.19; p = 0.8). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus one in the control group. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (RR = 1.002; 95% CI 0.57-1.75; p = 0.85). CONCLUSION: Preoperative MRI increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates.

Análise da incidência de quedas e a influência da fisioterapia no equilíbrio e na instabilidade postural de pacientes com Doença de Parkinson / Analysis of falls incidence and the influence of physical therapy on balance and postural instability of patients with Parkinson’s Disease

Os pacientes com Doença de Parkinson (DP) estão mais propensos a cair, pois soma-se aos sintomas da doença o fator idade, contribuindo ainda mais para tornar as quedas freqüentes e agravantes. Este estudo objetivou investigar a incidência de quedas e verificar a eficácia da fisioterapia sobre o equilíbrio e a instabilidade postural na DP. Doze pacientes com diagnóstico de DP, idade média de 68,42 ± 12 anos, realizaram fisioterapia em solo, durante 6 meses e foram avaliados bimestralmente através da Escala UPDRS e do Teste de Alcance Funcional (AF), além de um Diário de Quedas recolhido mensalmente. Para análise estatística foi aplicado o Teste de Friedman, ANOVA e Correlação de Pearson (p ≤ 0,05). Os resultados mostraram aumento significativo da pontuação total da escala UPDRS (p = 0,0038), porém sem diferença significativa para a pontuação da seção III (exploração motora), p = 0,065. Não houve aumento significativo do AF (p = 0,3095), mas observou-se declínio das quedas; também verificamos correlação negativa dos valores do AF com a pontuação da seção III da escala. Assim, concluímos que apesar de tratar-se de uma doença degenerativa, a fisioterapia pode ser eficaz na melhora do equilíbrio e na diminuição da incidência de quedas desses pacientes.

Patients with Parkinson’s Disease (PD) have more incidence of falls, because added to symptoms is associated the aging factor, contributing to produce frequent and serious falls. This study aimed to investigate the incidence of falls and check the efficacy of physical therapy on balance and postural instability in PD. Twelve patients with PD, average age 68.42 ± 12 years old, were submitted to physical therapy on the floor for 6 months and were evaluated each 2 months through the Unified Parkinson Disease Rating Scale (UPDRS) and Functional Reach Test (FR); also a monthly diary on falls was collected. For statistical analysis, a Friedman Test, ANOVA and Pearson Correlation (p ≤ 0.05) were applied. The results showed a significant increase in UPDRS total score (p = 0.0038), but with no significant difference to section III score (motor exploration), p = 0.065. There was no significant increase of FR (p = 0.3095), but it was noticed a reduction of falls; also there was an inverse correlation of FR values with section III score. Therefore, we conclude that although this disease is degenerative, physical therapy can be efficient to improve balance and to reduce the incidence of falls in these patients.