Evaluation of mammographic density and (99m)Tc-sestamibi scintimammographic uptake in postmenopausal women on hormone replacement therapy.

OBJECTIVE: To evaluate changes in mammographic density and (99m)Tc-sestamibi scintimammographic uptake in postmenopausal women on hormone replacement therapy (HRT). METHODS: Seventy-five postmenopausal women were prospectively studied and allocated into three groups: 50 women were randomized to either Group 1 (G1, n=25), which received 2mg of 17beta-oestradiol continuously combined with 1mg of norethisterone acetate (E2/NETA, Kliogest, Medley) or Group 2 (G2), which received 2.5mg/day of tibolone (Livial, Organon). The remaining 25 women, who were asymptomatic and had no desire to undergo HRT, constituted the control group (G3). Each patient was submitted to both mammography and scintimammography at baseline and after six months. Mammographic density was evaluated by using the BI-RADS classification system. The classification system of Barros et al. was used in the interpretation of scintimammography. For statistical analysis, the Chi-square test, ANOVA and Pearson's correlation were used. RESULTS: At six months, increased mammographic density was observed in 48% of G1, 12% of G2 and 16% of G3 patients (p<0.001). The increase in sestamibi uptake was 56% in G1, 28% in G2 and 24% in G3 (p<0.001). Increases in both density and uptake were significantly higher in the group on E2/NETA than among tibolone users and the controls. CONCLUSION: In postmenopausal women, HRT with E2/NETA was associated with increased mammographic density and increased (99m)Tc-sestamibi scintimammographic uptakes, suggesting greater mithochondrial activity in the cells of the mammary duct. This was not observed in users of 2.5 mg of tibolone, demonstrating that the effects on the breast were reduced. The same was observed in the control group.

A pilot study of hormone replacement therapy with tibolone in women with mastopathic breasts.

OBJECTIVE: Our purpose was to investigate the effect of tibolone in a prospective randomized, double-blind pilot study in postmenopausal women with clinically palpable mastopathic changes. METHODS: Twenty postmenopausal non-users of hormone replacement therapy undergoing mammography were randomly allocated to receive either 2.5 mg tibolone (Livial, Organon) or placebo (2 mg lactose). Mammographic density according to the Wolfe classification, severity of breast discomfort, parity, smoking habits, body weight and follicle-stimulating hormone (FSH) and estradiol (E(2)) levels were documented at baseline and after 6 months of treatment. RESULTS: There were no statistically significant differences between the two treatment groups in terms of parity, smoking, body weight and FSH and E(2) levels. At 6 months, four patients in the tibolone group showed reduced breast density, compared with one patient in the placebo group. Whereas no significant differences were found between the two treatment groups when the categories 'minimal reduction' and 'reduction' in mammographic density were combined, combination of the categories 'no change' and 'minimal reduction' showed a significant difference (P<0.036). Also, women in the tibolone group showed a statistically significant improvement in breast discomfort (P<0.019). CONCLUSION: This pilot study showed decreases in breast density as well as an attendant significant alleviation of breast discomfort in women with baseline mastopathic changes treated with tibolone for 6 months, which may be due to the inhibitory effect of tibolone on the enzymes involved in the biosynthesis of estradiol demonstrated in previous trials and should be further evaluated in long-term studies.

[Treatment of pain due to unwanted lactation with a homeopathic preparation given in the immediate post-partum period]. / Traitement de la douleur de la montée laiteuse non souhaitée par homéopathie dans le post-partum immédiat.

Dopaminergic agonists, such as Parlodel((R)), are now widely used to inhibit lactation. However, some countries, such as the United States, no longer use these drugs in this indication because of their sometimes serious adverse effects. In this context, the authors tested a homeopathic treatment designed for parturients unable or not wanting to breastfeed. The APIS MELLIFICA 9 CH and BRYONIA 9 CH combination was chosen for its anti-inflammatory and analgesic effects. 71 patients were included in this double-blind placebo-controlled study. All received basic treatment comprising naproxen and fluid restriction. A significant improvement of lactation pain (main criterion of the study) was observed in parturients treated with homeopathy (p<0.02 on D2 and p<0.01 on D4). A similar effect (p<0.05 on D4) was observed for breast tension and spontaneous milk flow. No significant difference was observed for the other criteria of the study. The homeopathic combination studied was therefore effective on the pain of lactation and should be integrated into the therapeutic armamentarium.

Tratamento de mamas tuberosas com incisões combinadas / Treatment of tuberous breast with combined incisions

INTRODUÇÃO: A deformidade tuberosa da mama é uma rara entidade, descrita por Rees e Aston em 1976. O desenvolvimento mamário encontra-se alterado, com herniação do parênquima pelo complexo areolopapilar, alargamento dessa estrutura e hipoplasia do tecido mamário, principalmente nos quadrantes inferiores. A mama, portanto, adquire um aspecto tubular ao invés do aspecto cônico natural. MÉTODO: No total, 4 pacientes foram submetidas a tratamento cirúrgico em um único tempo, com incisões combinadas: inframamária e periareolar. Detalhes técnicos devem ser individualizados para cada caso, conforme a gravidade e a classificação do tipo de mama tuberosa. RESULTADOS: O procedimento cirúrgico utilizado aborda todos os aspectos da deformidade da mama tuberosa em operação de um estágio. Cirurgia de revisão de cicatriz periareolar não foi necessária em nenhum caso. Em todos os casos, obteve-se resultado estético final aceitável e com satisfação da paciente e do cirurgião. O procedimento adotado não interfere em lactações futuras. CONCLUSÕES: A mama tuberosa representa um verdadeiro desafio terapêutico. A técnica utilizada é muito atraente e mostra resultados confiáveis e reprodutíveis.

BACKGROUND: Tuberous breast deformity is a rare entity, first described by Rees and Aston in 1976. In this condition, breast development is altered, with herniation of the parenchyma through the nipple-areolar complex, enlargement of this structure, and hypoplasia of the breast tissue, especially in the lower quadrants. The breast thus acquires a tubular shape rather than the natural conical look. METHODS: Four patients underwent a single surgical treatment, with combined inframammary and periareolar incisions. Technical details must be individualized for each case depending on the severity and classification type of the tuberous breasts. RESULTS: The surgical procedure used covers all aspects of tuberous breast deformity in a single-stage operation. Revision of periareolar surgery scar was not necessary in any case. In all cases, the final aesthetic result was satisfactory for the patient and the surgeon. The procedure adopted does not interfere with future lactation. CONCLUSIONS: Tuberous breast represents a real therapeutic challenge. The technique reported herein is very attractive and provides reliable and reproducible results.

Effects of tibolone on the breast of postmenopausal women.

For decades, hormone therapy (HT) has been the mainstay for managing menopausal symptoms. However, the prolonged use of either single estrogen therapy (ET) or a combination therapy of estrogen and progestogen (EPT) might be associated with a slightly increased risk of breast cancer. Alternative therapies that are effective in the prevention and/or treatment of menopause, having associated morbidities but no unwanted effects, are of primary interest in clinical practice. Tibolone (Livial; NV Organon, Oss, The Netherlands) is structurally related to 19-nortestosterone derivatives and is a new postmenopausal regimen with a unique pharmacological profile, licensed for the relief of climacteric symptoms and the prevention of osteoporosis in postmenopausal women. Tibolone exhibits weak estrogenic, progestogenic, and androgenic activities, which in theory might influence the breast. The effect of tibolone on breast tissue, however, is obscure. The purpose of this study was to assess the effects of tibolone on breast safety, and the collected data include preclinical models, clinical observation, and epidemiologic study. Although in vitro studies showed conflicting results (with the majority being favorable effects) regarding the effects of tibolone on breast cells, in vivo studies showed favorable effects of tibolone on the breast in animal models. Similarly, an epidemiologic study indicated an increased risk of breast cancer when tibolone was used to manage climacteric symptoms of postmenopausal women, but accumulated data obtained from radiologic studies (mammography) showed a possible protective effect of tibolone on the breast. Taken together, we conclude that tibolone, if not superior to conventional HT, may be more acceptable to clinicians as a therapeutic drug option for use with symptomatic menopausal women. Only time will tell whether tibolone will be the preferred option.

Ovulation inhibitors containing cyproterone acetate or desogestrel in the treatment of hyperandrogenic symptoms.

An open, randomized, multicenter study was carried out to compare two oral contraceptives as regards their therapeutic efficacy in androgenization symptoms such as acne, seborrhea and hirsutism in women. The preparations used were the combination of 2 mg cyproterone acetate (CPA) with 0.035 mg ethinyl estradiol (EE) (Diane 35, Schering AG, Berlin-West) and 0.150 mg desogestrel (DG) with 0.03 mg ethinyl estradiol (Marvelon, Organon, Oss, The Netherlands). The duration of therapy was 9 months. The combination of CPA-EE was used by 83 patients for 658 cycles and the combination of DG-EE by 79 women for 618 cycles. No pregnancy occurred under either therapy. Both preparations are well tolerated. However, some side-effects, such as reduced libido, nervousness and breast tenderness, were observed more frequently (p less than 0.05) in the DG-EE group than among the users of the CPA-EE combination. The therapeutic outcome was better in the CPA-EE group, especially in cases of facial acne (p less than 0.05). Seborrheic symptoms also responded better to the CPA-EE therapy. The results show that the CPA-EE combination is superior to the DG-EE combination in the treatment of acne and seborrhoea.

Técnica de Costa Lima nas hipertrofias mamárias associada ao retalho de pedículo vascular inferior / Costa Lima technique in mammary hypertrophy associated with inferior vascular pedicles

Introdução: A hipertrofia mamária é causa comum de sofrimento físico e emocional das mulheres. A técnica de Costa Lima busca tratar esta anormalidade e facilitar a elevação do complexo aréolo-mamilar (CAM). Objetivos: Avaliar a efetividade da técnica de Costa Lima nas hipertrofias mamárias e gigantomastias quando existe dificuldade na ascensão do CAM. Método: Entre julho de 1998 e junho de 2009, foram operadas 118 pacientes com hipertrofias grau II e III, com IMC entre 18,5 e 39,9, com medida da distância entre o ponto “A” de Pitanguy e o CAM entre 6 e 19,5 cm. Nesta técnica é utilizada marcação de Pitanguy, amputando-se a base mamária, sendo retirado do pólo superior um segmento trapezoidal sub areolar, que determina um retalho areolado dermoglandular fino, que é mobilizado cranialmente com facilidade. Resultados: A maior incidência de hipertrofias foi de 3º grau (50,85%), eutróficas (42,37%), predominante na segunda década (31,36%), com 0,85% de ocorrência de trombose venosa profunda, sob anestesia geral em 84,75%. O benefício foi conseguir mamas cônicas, em harmonia com o tronco, sem dificuldades em elevar o CAM, com observação de necrose parcial em 3,39% dos casos. Conclusão: A técnica mostrou-se vantajosa pela fácil mobilização do CAM, podendo ser aplicada na terapêutica cirúrgica.

Introduction: Mammary hypertrophy is common cause of physical and emotional suffering among women. The Costa Lima technique endeavors to treat this abnormality and ease the rising of the mammary areole complex (MAC). Objective: To evaluate the effectiveness of the Costa Lima technique in mammary hypertrophy when there is difficulty with the ascension of the MAC. Methods: Between July 1998 and June 2009, were operated patients with II and III with BMI between 18.5 and 39.9, with an average distance between the point “A” of Pitanguy and the MAC between 6 and 19.5 centimeters. The Pitanguy marking system is used in this technique, amputating the mammary base, by which a trapezoidal sub-areole segment is removed from the superior pole which enjoins a thin areole dermalglandular shred which is easy to cranially mobilize. Results: The greatest incidence of hypertrophy was of third degree (50.85%), eutrophic (42.37%), mostly in the second decade (31.36%), with a 0.86% occurrence rate of deep venous thrombosis, under general anesthesia at 84.75%. The benefit was being able to shape conic breasts in harmony with the trunk, with not difficulties in raising the MAC, which showed partial necrosis in 3.39% of cases. Conclusion: The technique showed it self to be advantageous due to the easy mobilization of the MAC and could be applied in therapeutic surgery.

Pathologies du sein / Brest pathologies

Le sein fait rêver. Il inspire souvent le poète, le peintre ou encore le sculpteur et pourtant cette merveilleuse partie anatomique de la femme qui révèle toute sa féminité et qui implique le désir peut être le siège de nombreux soucis. Différents médicaments homéopathiques peuvent nous aider... (AU)