Saving the Male Breast: A Systematic Literature Review of Breast-Conservation Surgery for Male Breast Cancer.

BACKGROUND: Male breast cancer (MBC) management is extrapolated from female BC. Mastectomy remains the most frequently used surgical procedure for male breast cancer (MBC). We performed a literature review to assess the use of breast-conservation (BCS) in MBC as well as outcomes following BCS. METHODS: A systematic literature was performed, and articles screened to identify studies that measured overall survival (OS), disease-free survival (DFS), or local recurrence (LR) in patients undergoing BCS. Weighted averages based on study size were performed for LR, DFS, and 5-year OS. RESULTS: Eight studies met the inclusion criteria with male breast surgery cases, and 859 (14.7%) underwent BCS. The mean follow-up time was 53 months, and mean age was 62.6 years, with stage II as the most common presentation. Two studies reported that 50-71.4% of patients underwent sentinel lymph node biopsy, and four studies reported axillary lymph node dissection in 14.3-100%. Five studies reported on adjuvant radiation therapy in 12.0-100% of total patients undergoing BCS. Four studies reported use of hormonal therapy in 73.8-100% of patients. Four studies reported use of chemotherapy in 25-66.7% of patients. Seven studies reported LR among 116 patients, with a weighted average of 9.9%. Three studies reported on DFS in 14 patients, with a weighted average 85.6%. Two studies report OS in 143 patients with a weighted average of 84.4%. CONCLUSIONS: Breast conservation may be considered a safe alternative in the surgical treatment of MBC. Future research should focus on better standardization of local therapy for MBC and improved reporting of outcomes.

Prokaryotic communities of acidic peatlands from the southern Brazilian Atlantic Forest

The acidic peatlands of southern Brazil are ecosystems essential for the maintenance of the Atlantic Forest, one of the 25 hot-spots of biodiversity in the world. In this work, we investigated the composition of prokaryotic communities in four histosols of three acidic peatland regions by constructing small-subunit (SSU) rRNA gene libraries and sequencing. SSU rRNA gene sequence analysis showed the prevalence of Acidobacteria (38.8%) and Proteobacteria (27.4%) of the Bacteria domain and Miscellaneous (58%) and Terrestrial (24%) groups of Crenarchaeota of the Archaea domain. As observed in other ecosystems, archaeal communities showed lower richness than bacterial communities. We also found a limited number of Euryarchaeota and of known methanotrophic bacteria in the clone libraries.

Diversity of 16S rRNA genes from bacteria of sugarcane rhizosphere soil

Sugarcane is an important agricultural product of Brazil, with a total production of more than 500 million tons. Knowledge of the bacterial community associated with agricultural crops and the soil status is a decisive step towards understanding how microorganisms influence crop productivity. However, most studies aim to isolate endophytic or rhizosphere bacteria associated with the plant by culture-dependent approaches. Culture-independent approaches allow a more comprehensive view of entire bacterial communities in the environment. In the present study, we have used this approach to assess the bacterial community in the rhizosphere soil of sugarcane at different times and under different nitrogen fertilization conditions. At the high taxonomic level, few differences between samples were observed, with the phylum Proteobacteria (29.6 percent) predominating, followed by Acidobacteria (23.4 percent), Bacteroidetes (12.1 percent), Firmicutes (10.2 percent), and Actinobacteria (5.6 percent). The exception was the Verrucomicrobia phylum whose prevalence in N-fertilized soils was approximately 0.7 percent and increased to 5.2 percent in the non-fertilized soil, suggesting that this group may be an indicator of nitrogen availability in soils. However, at low taxonomic levels a higher diversity was found associated with plants receiving nitrogen fertilizer. Bacillus was the most predominant genus, accounting for 19.7 percent of all genera observed. Classically reported nitrogen-fixing and/or plant growth-promoting bacterial genera, such as Azospirillum, Rhizobium, Mesorhizobium, Bradyrhizobium, and Burkholderia were also found although at a lower prevalence.

Apoptotic ratios and mitotic abnormalities in 17-ß-estradiol-transformed human breast epithelial MCF-10F cells.

Treatment of human breast epithelial cells MCF-10F with 17-ß-estradiol has been reported to result in E2-transformed cells which have given rise to highly invasive C5 cells that in turn generate tumors in SCID mice. From these tumors, various cell lines, among which C5-A6-T6 and C5-A8-T8, were obtained. Although different phases of the tumorigenesis process in this model have been studied in molecular biology and image analysis assays, no cytological data on apoptotic ratios and mitotic abnormalities have been established to accompany the various steps leading to 17-ß-estradiol-treated MCF-10F cells to tumorigenesis. Here we detected that the apoptotic ratio decreases with the transformation and tumorigenesis progress, except for the tumor cell line C5-A8-T8, probably on account of its more intense proliferation rate and a more rapid culture medium consumption. Increased frequency of mitotic abnormalities contributed by triple- and tetrapolar metaphases, and by lagging chromosomes and chromosome bridges observed at the anaphase found by transformation and tumorigenesis progress. However, no difference was found under these terms when the C5-A6-T6 and C5-A8-T8 tumor cell lines were compared to each other. Present findings are in agreement with the nuclear instability and enrichment of dysregulated genes in the apoptotic process promoted by transformation and tumorigenesis in 17-ß-estradiol-treated MCF-10F cells.

Apoptotic ratios and mitotic abnormalities in 17-Beta-estradiol-transformed human breast epithelial MCF-10F cells / Índices apoptóticos e anormalidades mitóticas em células epiteliais mamárias humanas MCF-10F transformadas pelo 17-Beta-estradiol

Treatment of human breast epithelial cells MCF-10F with 17-β-estradiol has been reported to result in E2-transformed cells which have given rise to highly invasive C5 cells that in turn generate tumors in SCID mice. From these tumors, various cell lines, among which C5-A6-T6 and C5-A8-T8, were obtained. Although different phases of the tumorigenesis process in this model have been studied in molecular biology and image analysis assays, no cytological data on apoptotic ratios and mitotic abnormalities have been established to accompany the various steps leading to 17-β-estradiol-treated MCF-10F cells to tumorigenesis. Here we detected that the apoptotic ratio decreases with the transformation and tumorigenesis progress, except for the tumor cell line C5-A8-T8, probably on account of its more intense proliferation rate and a more rapid culture medium consumption. Increased frequency of mitotic abnormalities contributed by triple- and tetrapolar metaphases, and by lagging chromosomes and chromosome bridges observed at the anaphase found by transformation and tumorigenesis progress. However, no difference was found under these terms when the C5-A6-T6 and C5-A8-T8 tumor cell lines were compared to each other. Present findings are in agreement with the nuclear instability and enrichment of dysregulated genes in the apoptotic process promoted by transformation and tumorigenesis in 17-β-estradiol-treated MCF-10F cells.

O tratamento das células epiteliais mamárias humanas MCF-10F com 17-β-estradiol tem sido relatado como resultando nas células transformadas E2, que deram origem às células C5, altamente invasivas, e que geraram tumores em camundongos SCID. A partir desses tumores foram originadas em cultura células tumorais, dentre as quais C5-A6-T6 e C5-A8-T8. Embora diversas fases do processo tumorigênico neste modelo tenham sido estudadas por ensaios de biologia molecular e análise de imagem, não foram ainda estimados dados citológicos referentes a índices apoptóticos e anomalias mitóticas que acompanhassem os vários passos que levam as células CF-10F tratadas com 17-β-estradiol à tumorigênese. Neste trabalho detectamos que o índice apoptótico decresce com a transformação e o avanço da tumorigênese, exceto na linhagem celular tumoral C5-A8-T8, provavelmente por causa de sua velocidade de proliferação mais intensa, que poderia levá-la a um consumo mais rápido do meio de cultura presente e à morte celular. Um aumento na frequência de anomalias mitóticas contribuídas por metáfases tripolares e tetrapolares e por pontes cromossômicas e cromossomos desgarrados, identificáveis na anáfase, foi observado com a transformação e o progresso da tumorigênese. Contudo não foram detectadas diferenças nesses parâmetros quando se compararam as linhagens tumorais C5-A6-T6 e C5-A8-T8 entre si. Os presentes achados estão de acordo com a instabilidade nuclear e o enriquecimento em desregulação de genes que atuam no processo apoptótico, promovidos pela transformação e tumorigênese nas células MCF-10F tratadas com 17-β-estradiol.

Topical anesthesia versus sub-Tenon block for cataract surgery: surgical conditions and patient satisfaction.

PURPOSE: To compare the surgical conditions and complications and patient and surgeon satisfaction in cataract surgery by phacoemulsification under topical anesthesia (TA) versus sub-Tenon block (STB). METHODS: Prospective randomized comparative blind study, without placebo control. Patient satisfaction evaluated by the Iowa Satisfaction with Anesthesia Scale (ISAS). RESULTS: The authors prospectively enrolled 59 patients (61% female) in the study, who were randomized into groups: 26 in the TA group and 33 in the STB. There was no statistically significant difference between the groups in terms of age, sex, waiting time for surgery, ASA (American Society of Anesthesiologists) state, eye laterality, cataract density, pupillary dilation, or surgery duration, but patient collaboration was better in the STB group. We found a mean 2.2 mmHg post-anesthetic rise in intraocular pressure in the STB group, with normalization at 24 hours, and no rise in the TA group. Subconjunctival hemorrhage and chemosis were more prevalent in the STB group, and the improvement of visual acuity was similar in both groups. Subjective satisfaction with the anesthetic technique, both for the surgeon and for the patient, was more elevated in the STB group. The final ISAS scores were 1.87 in the TA group and 2.71 in the STB (p<0.005). CONCLUSIONS: The data indicate that more significant anesthesia and analgesia was achieved with the STB, leading to more favorable surgical conditions and enhanced patient and surgeon satisfaction.

[Duodenal duplication in adult simulating pancreas pseudocyst]. / Duplicação duodenal em adulto simulando pseudocisto de pâncreas.

An adult patient with clinical and radiologic evidence of pancreas pseudocyst was undergone at laparotomy and a diagnosis of duodenal duplication was made. Due to the rarity of this case, a review of the literature is presented and the authors discuss the treatment of duodenal duplication.

Cine magnetic resonance imaging and color Doppler flow mapping in infants and children with pulmonary artery bands.

Cine magnetic resonance imaging (MRI) and color Doppler flow mapping were performed in 12 infants and children (aged 3 to 35 months) after pulmonary artery banding to define the anatomy and physiology of the right ventricular outflow tract and evaluate the anatomy. MRI was performed using a 1.5 Tesla magnet in the sagittal, axial and oblique views with all patients studied in the 24 cm head coli following adequate sedation. High-resolution cine MRI was obtained in all patients and the narrowest flow diameter on cine MRI correlated well with the pressure gradient measured across the band in 11 patients at cardiac catheterization or surgery (r = -0.95). Signal loss was always seen distal to the band associated with turbulent flow as seen by color Doppler flow mapping. Signal loss in cine MRI was also seen proximal to the band. The length of this proximal signal void also correlated well with the pressure gradient measured across the band (r = 0.91) and was closely matched by the zone of proximal spatial acceleration defined by digital computer analysis of color Doppler flow map images (r = 0.89), which also demonstrated low grade variance associated with the laminar accelerating flow stream. The position of the band was accurately defined by cine MRI which identified inadequate pulmonary artery banding in 2 patients confirmed subsequently at cardiac catheterization and angiography. Cine MRI and color Doppler flow mapping when used together provide high-resolution detail about the right ventricular outflow tract and pulmonary artery band anatomy and function.(ABSTRACT TRUNCATED AT 250 WORDS)

Color Doppler diagnosis of mechanical prosthetic mitral regurgitation: usefulness of the flow convergence region proximal to the regurgitant orifice.

In prosthetic or paravalvular prosthetic mitral regurgitation, transthoracic color Doppler flow mapping can sometimes fail to detect the regurgitant jet within the left atrium because of the shadowing by the prosthetic valve. To overcome this limitation, we assessed the utility of color Doppler visualization of the flow convergence region (FCR) proximal to the regurgitant orifice in 20 consecutive patients with mechanical prosthetic mitral regurgitation documented by surgery and cardiac catheterization (13 of 20 patients). In addition, we studied 33 patients with normally functioning mitral prostheses. Doppler studies were performed in the apical, subcostal, and parasternal long-axis views. An FCR was detected in 95% (19 of 20) of patients with prosthetic mitral regurgitation. A jet area in the left atrium was detected in 60% (12 of 20) of patients. In 18 of 19 patients with Doppler-detected FCR, the site of the leak was correctly identified by observing the location of the FCR. A trivial jet area was detected in eight patients with a normally functioning mitral prosthesis; in none was an FCR identified. Thus color Doppler visualization of the FCR proximal to the regurgitant orifice is superior to the jet area in the diagnosis of mechanical prosthetic mitral regurgitation. Moreover, FCR permits localization of the site of the leak with good accuracy.

Citodiagnostico en la patologia tumoral dermatologica / Citodiagnosis in tumoral cutaneous pathology

Fue el objetivo de este estudio realizar la comapración entre la citología y la histología de lesiones dermatológicas a efectos de determinar si el citodiagnóstico es válido para ser aplicado en la patología cutánea. Fueron incluidos dentro del protocolo 150 casos con diagnóstico clínico presuntivo de patología tumoral maligna. Los resultados fueron evaluados de acuerdo a la patología en general, a cada patología en particular y a la forma en que fue obtenida la toma. Para evaluar la utilidad desde el punto de vista dermatológico se recurrió a pruebas de discriminancia, tomando como base diagnóstica de certeza aquella arrojada por la histopatología, con los siguientes resultados: Sensibilidad: 63,26%, Especificidad: 88,46%, Valor Predictivo +: 91,18% y Valor Predictivo-: 56,10%. Los resultados fueron exitosos en el caso de los epiteliomas basocelulares, altamente orientadores en las metástasis de melanoma e insatisfactorios en epiteliomas espinocelulares. Si se considera la frecuencia de os epitelios basocelulares dentro de la patología tumoral dermatológica, el citodiagnóstico se constituye en un recurso rápido y económico, que ocasionando un mínimo de incomodidad al paciente puede agilizar el plan de estudio establecido. No excluye ni invalida la realización de la anatomía patológica tisular

Color Doppler flow mapping in patients with coarctation of the aorta: new observations and improved evaluation with color flow diameter and proximal acceleration as predictors of severity.

We performed color Doppler flow mapping in 15 patients, 1 week to 17 years old (mean 42 months), with coarctation of the aorta that was confirmed subsequently by angiography and/or surgery. Twelve patients had native coarctation and three had mild recoarctation after surgical repair. Color Doppler flow maps were analyzed with a digital analysis package and a Sony computer system. The diameter in the region of coarctation from the color Doppler flow map (mean = 2.0 +/- 0.8 mm [SD]) correlated well with the coarctation diameter measured at angiography (mean = 1.8 +/- 0.8 mm; r = .83, SEE 0.43 mm) in the 10 patients with native coarctation undergoing angiography, but the coarctation diameter measured by two-dimensional echocardiography (3.9 +/- 1.5 mm) was poorly predictive of the angiographic severity (r = .23). Additionally, spatial acceleration was seen in all patients proximal to the coarctation site, with an aliased and accelerating stream narrowing progressively as it proceeded toward the coarctation site, a pattern that is not seen in healthy subjects. Computer analysis of the color Doppler images provided pseudo three-dimensional and digital velocity maps for blue, red, and green (turbulent) flow velocities to allow an enhanced appreciation of the accelerating stream, easily separating this from normal descending aortic aliasing patterns. The narrowing of the acceleration area in the proximal descending aorta (distal/proximal acceleration zone ratio) was also predictive of the angiographic severity of coarctation (r = .83). The distribution of low-level turbulence seen proximally paralleled the distribution of the proximal accelerating stream.(ABSTRACT TRUNCATED AT 250 WORDS)

[Connective tissue nevi, associated variety]. / Nevo conjuntivo, variedad asociada.

We made the subject's review of the connective naevus because a boy of thirteen years old has consulted us about it. He has it on the back, on the forearm and on the right, it is associated to a cavernous tubero angioma of the mouth, this eventuality was described and commented by McBurney and his coworkers (1979) in his article "Angiokeratomas, connective tissue nevus, hemangioma". We bring out its main characteristics based on publications and displays of national authors' cases and our experience achieved at the cathedra about this nevoid dysplasia, from universal rareness, motif that will help to increase the scarce statistics of associate connective tissue naevus.

Ruptured mitral chordae tendineae may be a frequent and insignificant complication in the mitral valve prolapse syndrome.

In this study, we performed 512 echocardiographic studies on 264 consecutive unselected patients with the idiopathic mitral valve prolapse syndrome. Twenty-eight patients (10.6%) had evidence of ruptured chordae tendineae of the mitral valve on M-mode examination and in 24 the diagnosis was confirmed by two-dimensional echocardiography. Mild to severe mitral insufficiency was proven in all of them by left ventriculography during cardiac catheterization. Eight patients underwent surgery to relieve symptomatic severe mitral regurgitation. At operation all had myxomatous degeneration of the mitral valve, two patients were found to have rupture of anterior mitral chordae, and six had rupture of posterior mitral chordae. Twenty (71%) patients with chordal rupture had either mild symptoms or were completely asymptomatic. It is concluded that chordal rupture in patients with the mitral valve prolapse syndrome may be present in asymptomatic patients and go undetected clinically in a substantial number of patients unless a high index of suspicion is maintained. Serial M-mode and two-dimensional echocardiographic studies are of importance in identifying the progression of prolapse findings and may reveal the natural history of this pathologic condition in asymptomatic patients.

Two-dimensional echo Doppler study of congenital disorders of the mitral valve.

To define the use of two-dimensional echocardiography (2DE) and Doppler methods for diagnosis of forms of congenital mitral stenosis, we studied 16 children, age range 2 months to 13 years, with congenital deformities of the mitral valve documented at cardiac catheterization. Thirteen had additional congenital heart defects, most commonly aortic stenosis or aortic coarctation. In eight patients features of mitral valve anatomy were observed and described during cardiac surgery and in one child the anatomy was verified by postmortem examination. 2DE studies allowed anatomic subclassification of 10 valves which had asymmetric or single dominant papillary muscles (parachute) and six which had arcade mitral valve attached by short chords to multiple diminutive papillary muscle heads. All patients' echoes exhibited shortened and thickened mitral chordae and doming of the mitral leaflets during diastole, and seven children had restricted mitral orifices imaged on the short-axis imaging plane. All seven of the patients studied by Doppler echocardiography had increased maximal transmitral inflow velocity (range 111 to 260 cm/sec) greater than the 95% confidence limits for mitral flow velocities in 34 normal children who served as the control group. Our study suggests that 2DE studies, especially when combined with Doppler interrogation, are sensitive for defining forms of congenital mitral stenosis.

Two-dimensional echocardiography for evaluation of metastatic cardiac tumors in pediatric patients.

We have studied five patients with metastatic cancer in whom two-dimensional echocardiography (2DE) demonstrated cardiac or pericardial involvement. Echo studies may guide the clinician in instituting and/or modifying cardiac and cancer therapy in such patients.

[Tuberous sclerosis: a multidisciplinary study of 15 cases]. / Esclerose tuberosa: estudo multidisciplinar de 15 casos.

Report of a multidisciplinary study of patients affected with tuberous sclerosis, 8 of them males and 7 females, with ages ranging from 19 months to 23 years; 11 of these cases were sporadic, while the remaining 4 cases lacked information regarding family data. The following skin signs were observed: Pringle's adenoma in 9 cases; achromatic spots in 9 cases; periungueal fibroma in 3 cases. One of the patients had a heart tumor. Two patients had borderline intelligence, while the other 13 were mentally retarded of varying degrees. Epileptic seizures were present in 13 patients, atypical absence and tonus crises were frequent. Three of the patients had had infantile spasms in the first year of life as the first neurological symptom of the disease. Computer assisted axial tomography was performed in 7 cases and was positive in all of them, by revealing intracranial calcifications even in 4 cases in which the standard X-ray pictures had been silent about this eventuality.

Clinical applications of Doppler echocardiography combined with two-dimensional cardiac imaging - a review

No presente artigo procuramos descrever os conceitos basicos bem como demonstrar os padroes normais de fluxo atraves das diferentes valvas cardiacas obtidos por meio da ecocardiografia Doppler combinada com imagem cardiaca obtida atraves da ecocardiografia bidimencional. Tambem descrevemos as mais recentes aplicacoes clinicas desta nova modalidade diagnostica. Enfoque especial foi dado a quantificacao de fluxo, isto e, medida estimativa do debito cardiaco e "shunts" esquerda - direita, bem como estimativa nao invasiva de gradientes pressoricos em pacientes acometidos de lesoes valvares tipo estenose. Enquanto maior experiencia se faz necessaria para aquisicao de conceitos definitivos, esta recente metodologia parece oferecer um novo campo para obtencao de dados de grande aplicabilidade clinica

Esclerose tuberosa: estudo multidisciplinar de 15 casos / Tuberose esclerosis: a multidisciplinary study of 15 cases

Sao apresentados os resultados de estudo multidisciplinar de 15 pacientes con esclerose tuberosa, 8 do sexo masculino e 7 do sexo feminino, com idades entre 19 meses e 23 anos; 11 foram considerados como casos esporadicos e, em 4, nao foi possivel precisar os antecedentes familiares.Foram observadas as seguintes manifestacoes cutaneas: adenoma de Pringle em 9 casos; manchas acromicas em 9 casos; fibroma periungueal em 3 casos. Dos 15 casos 13 apresentaram D.M., deficiencia mental, enquanto os outros 2 tinham inteligencia limitrofe. Com excecao de 2 pacientes, todos tinham crises epilepticas e os tipos de crises mais frequentemente observados foram as ausencias atipicas e as crises tonicas. Espasmos infantis estavam presentes em 3 casos e em apenas um caso o eletrencefalograma apresentou aspecto hipsarritmico. A tomografia axial computadorizada, realizada em 7 casos, revelou calcificacoes periventriculares em todos, mesmo naqueles que apresentaram RX simples de cranio normal (4 casos)

Residual shunting in the early postoperative period after closure of atrial septal defect: echocardiographic comparison of patch materials.

Residual shunting after surgical closure of septal defects is a common postoperative complication. In this study, contrast echocardiography was used to assess the effect of different surgical patch materials on early postoperative residual shunting. The study consisted of 44 patients (aged 3 days to 64 years) with simple or complex atrial septal defects. Total pulmonary-to-systemic flow ratios ranged form 1.8:1 to 4.0:1. Three methods were used to close the atrial septal defects: primary suture closure (n = 7), patching with thin, knit Teflon fabric (n = 13), and patching with thicker, low porosity, knit Teflon fabric (n = 24). Contrast echocardiographic injections were performed through central venous and left atrial lines positioned at operation for monitoring purposes. Ten of the 44 patients had residual shunts. In five of them, daily contrast studies showed progressive diminution in shunting with eventual resolution, but in the other five patients, shunting persisted beyond the first 5 postoperative days. Three of the latter five required reoperation for actual residual anatomic defects. No patient whose atrial septal defect was closed by either direct suture or thick, low porosity Teflon fabric had shunting detected at any time postoperatively. Our data confirmed temporary leakage across newly implanted intracardiac patches. However, shunts that persist beyond the first postoperative week indicate true anatomic residua and not porous patch material. If a patient's recovery is complicated, use of contrast echocardiography can determine whether a residual shunt is a causative factor. In patients with complex lesions in whom continued shunting during the early postoperative period may cause serious hemodynamic consequences, heavier, low porosity patch material can be useful.