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1.
Breast J ; 26(4): 725-728, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31659819

RESUMO

BACKGROUND: Post-mastectomy irradiation severely impairs skin trophicity resulting in poor prosthetic implant outcome. Autologous fat grafting improves skin quality allowing minimally invasive approach with prosthetic reconstruction. Here, we report our pilot experience of preoperative mechanotherapy to optimize lipofilling and subsequent prosthetic reconstruction outcome. METHODS: We retrospectively included 65 women that had breast reconstruction using autologous fat grafting and implant placement from 2012 to 2018 benefiting or not from mechanotherapy before the reconstructive procedure. Demographic and surgical outcomes were recorded. RESULTS: The volume of fat injected was significantly superior in the mechanotherapy group compared with the controls for the first and second lipofilling (259.3 mL vs 150.6 mL and 251.8 mL vs 154 mL, respectively). Sixteen patients among controls required a pre-expansion prosthesis compared with none in the endermology group. The prosthesis volume was smaller in the endermology group. Six patients in the endermology group had a reconstruction without prosthesis. The aesthetic score evaluated by patients was 4.8 with no statistically significant difference between the two groups. CONCLUSION: Preoperative skin mechanotherapy and postoperative skin mechanotherapy increase skin compliance. It is associated with a higher volume of fat injection and lower prosthesis volume. If confirmed in a prospective study, endermology could become a standard in patients' preparation for lipofilling-based reconstruction.


Assuntos
Neoplasias da Mama , Mamoplastia , Tecido Adiposo , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Estudos Prospectivos , Estudos Retrospectivos
2.
Eur Radiol ; 27(3): 1064-1073, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27300193

RESUMO

OBJECTIVES: To investigate the added value of diffusion-weighted (DW) magnetic resonance (MR) imaging in the detection of infection in pancreatic fluid collections (PFC). METHODS: Forty-patients with PFC requiring endoscopic-transmural drainage underwent conventional-MR and DW-MR imaging (b = 1000 s/mm2) before endoscopy. MR images were divided into two sets (set1, conventional-MR; set2, conventional-MR, DW-MR and ADC maps) and randomized. Two independent readers performed qualitative and quantitative (apparent diffusion coefficient, ADC) image analysis. Bacteriological analysis of PFC content was the gold standard. Non-parametric tests were used for comparisons. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were calculated for the two sets for both readers. Receiver operating characteristic curves (ROC) were drawn to assess quantitative DW-MR imaging diagnostic performance. RESULTS: For both readers, sensitivity, specificity, NPV, PPV and accuracy for infected PFCs were higher for set2 (P > .05). ADC were lower in infected versus non-infected PFCs (P ≤ .031). Minimum ADC cut-off: 1,090×10-3 mm2/s for reader 1 and 1,012×10-3 mm2/s for reader 2 (sensitivity and specificity 67 % and 96 % for both readers). CONCLUSION: Qualitative information provided by DW-MR may help to assess PFCs infection. Infected PFCs show significantly lower ADCs compared to non-infected ones. KEY POINTS: • DW improves MR diagnostic accuracy to detect infection of PFC • Infected PFCs show lower ADC compared to non-infected ones (P < .031) • DW-MR images are easy to interpret especially for non-experienced radiologist.


Assuntos
Infecções Bacterianas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Pancreatopatias/diagnóstico por imagem , Suco Pancreático/diagnóstico por imagem , Infecções Bacterianas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/patologia , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Rev Prat ; 65(6): 784-8, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-26298900

RESUMO

Depending on its location or stage, rectal cancer may differ significantly. Before any treatment decision a careful work up is mandatory relying mainly on endoscopy and imaging (MRI). Surgery according to the TME principle is the cornerstone of treatment. Most of the time surgery is associated with external beam radiotherapy often combined with concurrent chemotherapy (capecitabine) according to the neoadjuvant regimen CAP 50 (5 weeks long). It is sometimes possible to escalate safely the dose of irradiation using contact X-ray brachytherapy 50 Kv or Iridium 192 interstitial brachytherapy. Adjuvant chemotherapy may be given in case of pejorative pathological findings but its benefit is not yet proven in contrast with colon cancer. Local recurrences are becoming unusual as is permanent APE surgery with permanent stoma. To reduce the risk of distant metastasis clinical trials are testing first line chemotherapy in T3-4 lesions. For early stage (T2-"small" T3) clinical trials try to achieve organ preservation. Intensification of CAP 50 either with more chemotherapy or radiation dose escalation using contact X-ray aim at achieving a clinical complete response followed by local excision or close surveillance.


Assuntos
Assistência Perioperatória , Neoplasias Retais/terapia , Quimioterapia Adjuvante , Humanos , Tratamentos com Preservação do Órgão , Radioterapia Adjuvante
4.
J Clin Ultrasound ; 42(7): 444-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24449208

RESUMO

We describe a case of light chain deposition disease presenting as worsening of renal failure with a lytic femoral bone lesion discovered by sonography. Although sonography cannot be considered to be the test of choice in evaluating multiple myeloma, this technique may allow the detection and the biopsy of osteolytic bone lesions, particularly in accessible locations. Differential diagnosis is discussed.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Cadeias Leves de Imunoglobulina/metabolismo , Mieloma Múltiplo/diagnóstico por imagem , Doenças Ósseas/etiologia , Doenças Ósseas/metabolismo , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/metabolismo , Ultrassonografia
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