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1.
BMC Public Health ; 8: 251, 2008 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-18647383

RESUMO

To estimate the prevalence of metabolic syndrome (MS) in a population receiving attention in primary care centers (PCC) we selected a random cohort of ostensibly normal subjects from the registers of 5 basic-health area (BHA) PCC. Diagnosis of MS was with the WHO, NCEP and IDF criteria. Variables recorded were: socio-demographic data, CVD risk factors including lipids, obesity, diabetes, blood pressure and smoking habit and a glucose tolerance test outcome. Of the 720 individuals selected (age 60.3 +/- 11.5 years), 431 were female, 352 hypertensive, 142 diabetic, 233 pre-diabetic, 285 obese, 209 dyslipemic and 106 smokers. CVD risk according to the Framingham and REGICOR calculation was 13.8 +/- 10% and 8.8 +/- 9.8%, respectively. Using the WHO, NCEP and IDF criteria, MS was diagnosed in 166, 210 and 252 subjects, respectively and the relative risk of CVD complications in MS subjects was 2.56. Logistic regression analysis indicated that the MS components (WHO set), the MS components (IDF set) and the female gender had an increased odds ratio for CVD of 3.48 (95CI%: 2.26-5.37), 2.28 (95%CI: 1.84-4.90) and 2.26 (95%CI: 1.48-3.47), respectively. We conclude that MS and concomitant CVD risk is high in ostensibly normal population attending primary care clinics, and this would necessarily impinge on resource allocation in primary care.


Assuntos
Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/epidemiologia , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Colesterol/sangue , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Fatores de Risco , Estudos de Amostragem , Espanha/epidemiologia , Triglicerídeos/sangue
2.
Radiographics ; 27 Suppl 1: S101-24, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18180221

RESUMO

During pregnancy and lactation, the breast can be affected by a variety of specific and unique disorders, including benign disorders closely related to physiologic changes, inflammatory and infectious diseases, juvenile papillomatosis, and benign and malignant tumors. Patients with pregnancy-associated breast carcinoma tend to have more advanced neoplasms at diagnosis and a poorer prognosis due to delayed diagnosis and a more aggressive biologic pattern. Pregnancy-related Burkitt lymphoma characteristically manifests with bilateral and diffuse involvement of the breasts. Fibroadenoma may manifest with growth, infarction, large cysts, prominent ducts, and secretory hyperplasia during pregnancy and lactation. Galactocele is the breast lesion most commonly found during lactation and manifests as either pseudolipoma, a cystic mass with a fat-fluid level, or pseudohamartoma. Tumors and diseases affecting the breasts during pregnancy and lactation are basically the same as those observed in nonpregnant women but may have a different appearance. The sensitivity of mammography in pregnant and lactating women is decreased due to increased parenchymal density. Instead, ultrasonography is the most appropriate radiologic method for evaluating breast masses in this setting and is particularly useful in the diagnosis and treatment of abscesses. Knowledge of the unique entities that are specifically related to pregnancy and lactation and of their radiologic-pathologic appearances can help the radiologist make the correct diagnosis.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/etiologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/etiologia , Lactação , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/etiologia , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/etiologia , Feminino , Humanos , Gravidez , Radiografia
3.
Eur Radiol ; 16(3): 702-6, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16208511

RESUMO

We describe the clinical, radiological, and pathological findings of the diverse benign and malignant breast neoplasms found in association with Cowden syndrome. Patients with Cowden syndrome had a substantially increased risk of breast carcinoma. We find that 33% of the patients in our study population with Cowden disease have developed breast carcinoma to date. An association between Cowden disease and multiple tubular adenomas or breast hamartomas was found in two patients, suggesting a genetic origin. PTEN germ-line mutations were found in all four patients presenting with relevant benign or malignant breast pathology. We also assess the value of specific diagnostic tools used in the surveillance management. Screening mammography was useful in the diagnosis of small, high-grade carcinomas.


Assuntos
Neoplasias da Mama/genética , Mutação em Linhagem Germinativa , Síndrome do Hamartoma Múltiplo/genética , PTEN Fosfo-Hidrolase/genética , Adolescente , Adulto , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Mamografia , Ultrassonografia Mamária
4.
Eur Radiol ; 16(1): 53-6, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15937681

RESUMO

Lupus panniculitis is an unusual immunological disease that characteristically affects the subcutaneous fat and occurs in 2% of patients with systemic lupus erythematosus. We report a case of lupus panniculitis involving the breast, which represents a very uncommon location. Mammographically, it presented as a suspicious irregular mass involving the subcutaneous fat pad with skin thickening. High echogenicity constituted the most relevant sonographic finding. To the best of our knowledge, the magnetic resonance (MR) features have not been previously described. High signal intensity was found on both T1- and T2-weighted precontrast MR images. A dynamic contrast-enhanced study revealed a suspicious focal mass with irregular margins and rim enhancement, with a type 3 time-signal intensity curve. Differential diagnosis with carcinoma and fat necrosis and the value of core biopsy are discussed.


Assuntos
Doenças Mamárias/diagnóstico , Mama/patologia , Paniculite de Lúpus Eritematoso/diagnóstico , Corticosteroides/administração & dosagem , Adulto , Biópsia/métodos , Doenças Mamárias/tratamento farmacológico , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Gadolínio DTPA , Humanos , Aumento da Imagem/métodos , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Paniculite de Lúpus Eritematoso/tratamento farmacológico , Doenças Raras
5.
Radiographics ; 25(2): 411-24, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15798059

RESUMO

The radiologic features of breast lesions caused by immunologic, reactive, and noncurrent infectious diseases often mimic those of malignancy, frequently constituting a diagnostic challenge even if the underlying disease is known. Churg-Strauss syndrome mimics carcinomatous mastitis. Amyloidosis usually manifests as a suspicious mass, often accompanied by microcalcifications. Wegener granulomatosis and sarcoidosis often manifest as irregular masses, although sarcoidosis can also manifest as round, well-defined masses reflecting intramammary node involvement. Diabetic mastopathy is a rare but well-known entity in patients with long-standing insulin-dependent diabetes. Breast involvement by necrobiotic xanthogranulomatosis is rare and manifests as multiple bilateral asymmetric lesions. Multiple clustered hypoechoic tubular structures in a large hypoechoic mass seen after pregnancy can be suggestive of granulomatous mastitis. Mammary tuberculosis can manifest with a nodular, diffuse, or sclerosing pattern. A granulomatous inflammatory reaction must be carefully evaluated because it constitutes the major feature of a diverse group of diseases that includes vasculitis, granulomatous mastitis, tuberculosis, and carcinoma-associated sarcoidlike reactions. Core biopsy can play a major role in developing a differential diagnosis for these rare immunologic, inflammatory, or infectious disorders affecting the breast, and knowledge of these entities can, in the appropriate clinical setting, help the radiologist narrow the differential diagnosis, although cancer must be excluded definitively.


Assuntos
Doenças Mamárias/diagnóstico , Adulto , Idoso , Doenças Mamárias/imunologia , Feminino , Humanos , Mastite/diagnóstico , Pessoa de Meia-Idade
6.
Int J Cancer ; 112(4): 647-52, 2004 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-15382046

RESUMO

Women with a family history of breast cancer are at increased risk for developing this neoplasm. Starting surveillance more frequently at a younger age than the general population and the possibility of undergoing genetic testing are options for their medical management. We analyzed the benefits and costs of our clinical program in familial breast cancer (FBC) and carried out a cost-effectiveness analysis of such procedure. The benefits and costs of performing genetic counseling and a screening program in FBC based on 143 high-risk families registered in our database between June 1995 and December 2001 were analyzed. A decision tree was constructed to estimate the survival benefit and cost-effectiveness of the clinical genetic counseling program compared with the strategy of not performing any screening protocol. We estimated that the prevalence of a BRCA mutation in an unaffected relative of our high-risk cohort was 10% and that 53% of the mutations are found in the BRCA1 gene. We assigned a 58.5% lifetime risk of breast cancer for a 30-year-old mutation carrier according to the SEER data. The effectiveness of the screening was obtained from our experience and data for estimating survival were derived from other studies with longer follow-up. We used our local payment data to calculate the costs of the program. A mutation in the BRCA1 or BRCA2 genes was identified in 20% of the probands. Seventy primary breast cancer cases were recorded since the onset of the program. Thirty percent of the tumors were diagnosed through the screening program and 71% of them were lymph node-negative compared to 49% of the tumors diagnosed outside the program (p=0.1). The cost-effectiveness ratio of our FBC genetic counseling and screening program was 4,294 euros per life-year gained. The model was sensitive to the prevalence of mutation carriers, the lifetime risk of breast cancer and the effectiveness of the screening. In our setting and according to our model, this analysis suggests that a program of genetic testing and screening for breast cancer in a high-risk population may be cost-effective. These results need to be confirmed as more effective interventions for cancer prevention and screening are being implemented.


Assuntos
Neoplasias da Mama/genética , Aconselhamento Genético/economia , Predisposição Genética para Doença , Testes Genéticos/economia , Idoso , Neoplasias da Mama/patologia , Análise Custo-Benefício , Análise Mutacional de DNA , Bases de Dados Factuais , Feminino , Humanos , Pessoa de Meia-Idade , Linhagem , Fatores de Risco , Análise de Sobrevida
8.
Eur Radiol ; 12(3): 646-9, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11870481

RESUMO

Churg-Strauss syndrome is a rare immunoallergic disorder that usually affects lungs, skin and nervous system. The clinical and radiological findings of Churg-Strauss disease involving the breast are reported and attention is drawn to the fact that, although uncommonly, the breast can be involved by immunological diseases.


Assuntos
Mama/patologia , Síndrome de Churg-Strauss/complicações , Eosinofilia/etiologia , Mastite/etiologia , Adolescente , Sedimentação Sanguínea , Síndrome de Churg-Strauss/diagnóstico por imagem , Eosinofilia/diagnóstico , Feminino , Humanos , Mamografia , Mastite/diagnóstico
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