RESUMO
PURPOSE: To assess the risk of cardiovascular disease (CVD) after postlumpectomy irradiation restricted to tangential fields. METHODS AND MATERIALS: We assessed the incidence of CVD in 1601 patients with T1-2N0 breast cancer (BC) treated with breast tangentials in five different hospitals between 1980 and 1993. Patients treated with radiation fields other than breast tangentials and those treated with adjuvant chemotherapy were excluded. For patients with left-sided BC, maximum heart distance (MHD) was measured on the simulator films as a proxy for irradiated heart volume. Risk of CVD by laterality and MHD categories was evaluated by Cox proportional hazards regression analysis. RESULTS: Follow-up was complete for 94% of the patients, and median follow-up was 16 years. The incidence of CVD overall was 14.1%, of ischemic heart disease 7.3%, and for other types of heart disease 9.2%, with a median time to event of 10 to 11 years. The incidence of CVD was 11.6% in patients with right-sided BC, compared with 16.0% in left-sided cases. The hazard ratio associated with left-sided vs. right-sided BC was 1.38 (95% confidence interval [CI], 1.05-1.81) for CVD overall, 1.35 (95% CI, 0.93-1.98) for ischemic heart disease , and 1.53 (95% CI, 1.09-2.15) for other heart disease, adjusted for age, diabetes, and history of CVD. The risk of CVD did not significantly increase with increasing MHD. CONCLUSIONS: Patients irradiated for left-sided BC with tangential fields have a higher incidence of CVD compared with those with right-sided cancer. However, the risk does not seem to increase with larger irradiated heart volumes.
Assuntos
Neoplasias da Mama/radioterapia , Doenças Cardiovasculares/epidemiologia , Coração/efeitos da radiação , Lesões por Radiação/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Incidência , Mastectomia Segmentar , Pessoa de Meia-Idade , Período Pós-Operatório , Modelos de Riscos Proporcionais , Doses de Radiação , Lesões por Radiação/mortalidadeRESUMO
A rare cause of malignant small bowel tumor is presented. Malignant melanoma, most likely metastatic, was diagnosed during emergency laparotomy for acute peritonitis caused by a perforated small bowel tumor. This case report emphasizes the need for a careful work-up of "non-specific" abdominal symptoms in patients with a medical history of cutaneous malignant melanoma, even after years of tumor-free follow-up.
Assuntos
Perfuração Intestinal/complicações , Neoplasias do Jejuno/complicações , Melanoma/secundário , Neoplasias Cutâneas/patologia , Idoso , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/etiologia , Neoplasias do Jejuno/patologia , Neoplasias Hepáticas/secundário , Peritonite/etiologiaRESUMO
False or pseudoaneurysm formation usually occurs after traumatic, iatrogenic or infective injury to the arterial wall. Despite the high incidence of pseudoaneurysm formation secondary to puncture injury to the common femoral artery false aneurysm formation of the profunda femoris artery (PFA) is a rare complication and has not been previously reported as a complication of orthopaedic surgery. We present a patient who developed a false aneurysm of the PFA secondary to arterial damage caused by a bone fragment dislodged during orthopaedic surgery for fracture of the femur.