Siliconoma mamario / Breast Siliconomas

Nuestra Unidad recibe por su área programática de influencia, pacientes de bajos recursos socioeconómicos y culturales que fueron sometidos a prácticas ilegales de inclusión de materiales de uso no médico por vía infiltrativa en las mamas y que requirieron trtamiento quirúrgico como consecuencia de haber causado procesos inflamatorios inespecíficos con deformidad y dolor invalidante. En el período comprendido entre el 26/10/2009 al 26/10/2010 en la Unidad de Cirugía Plástica del HZGA Dr. Lucio A. Meléndez de Adrogué tres pacients intervenidos quirúrgicamente por presentar siliconomas mamarios. El procedimiento de elección fue adenomastectomia subcutánea bilateral con reconstrucción posterior con implantes, con buenos resultados estéticos. El desconocimiento y las consecuencias por la aplicación infiltrativa de siliconas industriales en las mamas obligan al equipo de cirugía plástica a desarrollar nuevas tácticas para solucionr las consecuencias devastadoras que las mismas producen en los pacientes

Our Unit received for its program area of influence, patients with low socioeconomic and cultural resources that were subjected to illegal practices including non-medical use materials via infiltration in the breast and needed surgery as a consequence of nonspecific inflammatory processes caused by deformity and crippling pain. In the period from 26/10/2009 to 26/10/2010 in the Unit of Plastic Surgery Dr. Lucio A. HZGA Melendez Adrogué three patients undergoing surgery for breast siliconomas present. The election procedure was adenomastecty reconstruction after bilateral subcutaneous implants, with good aesthetic results. The ignorance and the consequences for the application infiltrative industrial silicone breast forces the plastic surgery team to develop new tactics to adress the devstating consequences that they produce in patients

Etiologia e perfil de sensibilidade de bactérias isoladas de ovelhas com mastite na região nordeste do estado do Pará / Etiology and antimicrobial susceptibilities of bacteria isolated from sheep with mastitis in northeastern Pará, Brazil

Objetivou-se com este trabalho estudar a etiologia da mastite em ovelhas na região nordeste do Pará, além de estabelecer o perfil de sensibilidade das bactérias isoladas frente a antimicrobianos. Foram examinadas 176 ovelhas da raça Santa Inês, em lactação, mantidas em sistema semi-intensivo, pertencentes a sete propriedades especializadas na criação de ovinos. Foi realizado o exame clínico da glândula mamária, o exame macroscópico da secreção láctea por meio do Teste da Caneca Telada, o California Mastitis Test (CMT), o exame microbiológico do leite e o antibiograma. Das 352 metades mamárias estudadas (176 ovelhas), 21 (5,97 por cento) apresentaram mastite clínica, 26 (7,39 por cento) apresentaram mastite subclínica e 305 (86,64 por cento) metades mamárias foram negativas. A maioria dos animais acometidos pela mastite estava no terço médio da lactação, com menor número de crias e maior número de lactações. Na mastite clínica (MC) as bactérias isoladas foram Staphylococcus spp. coagulase negativo (42,9 por cento); Staphylococcus aureus (9,52 por cento); Streptococcus spp. (4,76 por cento) e Escherichia coli (4,76 por cento). As associações observadas foram Staphylococcus aureus e Streptococcus spp. (4,76 por cento); Staphylococcus spp. coagulase negativo não hemolítica, Staphylococcus spp. coagulase negativo hemolítica e Staphylococcus spp. coagulase negativo pigmento não hemolítica (4,76 por cento). Já na mastite subclínica (MSC), as bactérias isoladas foram Staphylococcus spp. coagulase negativo (26,9 por cento); Staphylococcus aureus (15,4 por cento); Streptococcus spp. (7,69 por cento); Escherichia coli (7,69 por cento) e Citrobacter freundii (11,5 por cento). A associação observada foi Staphylococcus spp. coagulase negativo não hemolítica e Staphylococcus spp. coagulase negativo hemolítica (3,85 por cento). Os antimicrobianos com maior eficácia contra os agentes isolados Gram positivos foram penicilina/novobiocina (100 por cento), cefalotina (100 por cento) e florfenicol (100 por cento) e contra o Citrobacter freundii foram a ampicilina (100 por cento) e florfenicol (100 por cento). Já em relação a Escherichia coli, 66,7 por cento dos isolados mostraram-se resistentes à ampicilina, cefalotina, florfenicol e tetraciclina. A mastite está presente em ovelhas no estado do Pará, havendo a necessidade de estimar, em estudos futuros, as perdas econômicas causadas por essa enfermidade. O CMT apresentou resultados satisfatórios, podendo ser recomendado como teste de triagem para o diagnóstico de casos individuais de mastite subclínica em ovinos, uma vez que apresentou boa relação com o exame microbiológico. No antibiograma foi observado que a maioria dos agentes isolados apresenta-se sensível aos diferentes antimicrobianos testados, sendo os antibióticos com melhor eficiência o florfenicol e a cefoxitina.

The objective of this paper was to study the etiology of mastitis in sheep at northeastern Pará, and to establish the sensitivity of isolated bacteria to antibiotics. A total of 176 Santa Inês nursing sheep kept in semi-intensive system from seven properties were examined. The mammary gland was clinically examined and the milk was submitted to the Caneca Telada Test, the California Mastitis Test (CMT), bacteriological examinations and antibiograms. Out of the 352 mammary halves (176 sheep), 5.9 percent (21/352) had clinical mastitis and by the CMT test, 7.39 percent (26/352) had subclinical mastitis and 86.64 percent (305/352) mammary halves did not have mastitis. Most of the animals with mastitis were in the second third of the lactation period, had less kids and more lactation periods. The following bacteria were isolated from the clinical mastitis Staphylococcus spp. coagulase negative (42,9 percent); Staphylococcus aureus (9.52 percent); Streptococcus spp. (4.76 percent) and Escherichia coli (4.76 percent). Were observed associations of Staphylococcus aureus and Streptococcus spp. (4,76 percent); Staphylococcus spp. coagulase negative nonhemolytic, Staphylococcus spp. coagulase negative hemolytic and Staphylococcus spp. coagulase negative non hemolytic pigment (4.76 percent). Already in subclinical mastitis the bacteria isolated were Staphylococcus spp. coagulase negative (26.9 percent); Staphylococcus aureus (15.,4 percent); Streptococcus spp. (7.69 percent); Escherichia coli (7.69 percent) and Citrobacter freundii (11.5 percent). Were observed associations of Staphylococcus spp. coagulase negative nonhemolytic and Staphylococcus spp. coagulase negative hemolytic (3.85 percent). The most efficient antibiotics for the Gram positive agents were penicile/novobiocine (100 percent), cefalotine (100 percent) and florfenicol (100 percent) and for the Citrobacter freundii were ampicilina (100 percent) and florfenicol (100 percent). In relation to Escherichia coli, 66.7 percent of isolates to ampicillin, cephalothin, florfenicol and tetracycline were resistant. Mastitis is present in sheep in the State of Pará, and it's necessary to estimate, in future studies, the economic losses caused by this disease. The CMT show satisfactory results and can be recommended as a screening test for diagnosing individual cases of subclinical mastitis in sheep, once had a good relationship with the microbiological examination. In the antibiogram where most of the isolated agents appear sensitive to different antibiotics tested, the antibiotics with the best efficiency were florfenicol and cefoxitin.

Spectrum of breast tuberculosis

To determine the presentation of breast tuberculosis, diagnostic methods and surgical treatments. A case series. This study was conducted at Dow University of Health Sciences and Tuberculosis Clinic at Bantwa Hospital, Kharadar, Karachi, from April 1999 to March 2007. Clinically diagnosed patients of breast tuberculosis, confirmed by laboratory work-up, were included in this study. Detailed history and examination of both breast and axillae were the primary diagnostic measures. Complete blood counts, ESR, Mantoux test, ultrasound, mammogram, fine needle aspiration cytology, staining for acid-fast bacilli both smear and culture were performed. Core biopsy for lumps more than 5 cm and wide excision biopsy for the lump less than 5 cm were the methods applied. Pre-designed research proforma was filled and descriptive statistics of age, site, side, clinical presentations, investigations were recorded and surgical treatment done. Anti-tuberculosis treatment was given to all patients. Thirty patients were studied with mean age of 28.4 years ranging from 16-48 years. Bilateral breast involvement was seen in 2 patients with 14 cases involving the right and left breast. Lymph node involvement was present in 7. Pulmonary tuberculosis was seen in 4 patients. Multifocal disease was present in 27 patients. The clinical presentation was with lump in 6, discharging sinuses in 14, cold abscess in 8, and non-healing ulcer in 2 patients. There were 5 lactating mothers. Montoux test was positive in 5, AFB smear and culture were positive in 3. Only AFB culture was positive in 4. Five patients required core biopsy for diagnosis of confirmation of lump more than 5 cm and wide excision biopsy was required in 7 patients with lump less than 5 cm. Despite antituberculous treatment, surgical management was required in 21 [70%] cases. Tuberculosis of the breast, simulating the carcinoma breast and granulomatous mastitis very closely and are difficult to be differentiated without tissue diagnosis. Surgical management is more often required

[Lobular idiopathic granulomatos mastitis About 10 cases]

Our retrospective study was performed on 10 cases of granulo-matous mastitis registered in Obstetric Gynaecology Department and Pathology Department of CHU F. Hached Sousse, during 8 years period. The mean age was 36.4 years [range 32-59]. Among these 10 cases, 8 were observed in reproductive-age women and 2 were noted in menopausal women. Clinical findings showed unilateral breast nodule associated with inflammatory signis in 4 cases, mammelonary retraction in 2 cases and serous or sero-purulent mamelonnary flow in 4 cases. Mammographic examination suggested a malignant tumor in 5 patients. In all cases, the diagnosis is made by histopathology. Surgical treatment consisted in wide excision with drainage or radical mastectomy, eventually with combination with antibiotic therapy and non steroid anti-inflammatory drugs. Prognostic features showed a good cicatrisation in 4 cases, local recurrence and cutanonus fistulization in one patient. Granulomatous mastitis aetiology is still unclear, auto-immune aetio-pathologenesis appears more interesting and should be clarified

Granulomatous mastitis: Surgical outcomes

To report the clinical and pathological features and surgical treatment outcomes of patients with granulomatous mastitis. Case series. Ankara Oncology Training and Research Hospital, between 1999-2003. Data of 16 patients with granulomatous mastitis treated surgically by total excision with disease-free margins were reviewed. Patients given additional medical therapy or treated with mastectomy because of the size and extent of the disease were excluded. The mean age of patients at the time of diagnosis was 31.8 [range: 22-45 years]. All patients were diagnosed from the pathological tissue specimens obtained by surgery. Clinical and radiological examinations suggested breast carcinoma in 82.1% patients. Except one patient who developed a fistula from the incision which was treated again with surgery, no other complications were noted, including recurrence of disease during a median follow-up period of 12.8 months [range: 4-30 months]. Although granulomatous mastitis is a rare benign breast disease, it usually mimics breast carcinoma both clinically and radiologically, making the diagnosis difficult and challenging. As long as good cosmetic results can be achieved, surgical excision is quick, safe and effective treatment method for idiopathic granulomatous mastitis

Mastitis granulomatosa. Informe de 16 casos / Granulomatous mastitis. Report of sixteen cases

Se informan 16 casos de mastitis granulomatosa, visto en la clínica de mama del Hospital Regional de Río Blanco, Veracruz entre 1985-1996. La edad promedio fue de 41.7 años (rango 22-62 años), el promedio de gestaciones fue de cinco. El 50 por ciento tenía antecedentes de lactancia en los seis meses anteriores al inicio de la enfermedad, pero no hubo casos de mastitis puerperal. El 75 por ciento de los casos tenía la presencia de tumor mamario con tamaño promedio de 6 cm (2-10 cm de rango), que fue sospechoso de cáncer en 62.5 por ciento. En dos casos (12.5 por ciento) se encontró carcinoma mamario asociados y en un caso se demostró etiología por tuberculosis. El tratamiento fue quirúrgico en 100 por ciento con excisción local amplia en todos los casos excepto dos casos que requirieron de mastectomía. Se dio tratamiento antifímico en un caso, en ningún caso se usaron esteroides. Sólo hubo dos recurrencias en un tiempo promedio de seguimiento de 20 meses. Es necesario que todo cirujano dedicado a tratar problemas mamarios esté familiarizado con esta patología, también es importante su reconocimiento para los patólogos ya que el diagnóstico es hecho microscópicamente, generalmente a partir de una muestra amplia de tejido

Tuberculose mamária / Tuberculosis of the breast

A tuberculose mamária é rara. A incidência relatada varia entre 0,25 por cento e 4,5 por cento de todas as doenças mamárias tratadas cirurgicamente. Três casos de mastite tuberculosa sao relatados neste trabalho. Duas pacientes apresentaram mastite tuberculosa disseminada com múltiplas fístulas e uma a forma nodular da doença. Em todas as pacientes, o diagnóstico foi realizado através da biópsia da lesao com exame histológico. Todas receberam quimioterapia antituberculosa com excisao da lesao na forma nodular.

Abscesso subareolar: sugestäo de nova técnica cirúrgica / Subareolar abscess: sugestion of a new surgical technical

É apresentada uma técnica original para a cura do abscesso subareolar crônico recidivante, com dupla incisäo do mamilo e exerese da fístula com o sistema ductal principal, seguido de mamiloplastia. Säo discutidas as técnicas mais usuais e a patogenia desta afecçäo, justificando o nosso procedimento

Análise de 23.268 espécimes cirúrgicos de mama, 1968-1982 / Analysis of 23,268 surgical breast specimens, 1968-1982

Säo estudados os diversos tipos de patologias em espécimes cirúrgicos removidos das glândulas mamárias. É ressaltada a freqüência da mastopatia fibrosa, a qual mediante uma avaliaçäo judiciosa dos achados clínicos mamográficos e citológicos (punçäo com agulha fina) geralmente dispensa uma intervençäo cirúrgica. A importância das hiperplasias epiteliais também é considerada, por se tratarem de lesöes precursoras do carcinoma de mama, e cujo diagnóstico em espécimes cirúrgicos é um dos mais importantes fatores de risco para esta neoplasia