Analgesic, cardiorespiratory effects and motor block characteristics of epidural levobupivacaine alone or in combination with methadone or dexmedetomidine in bitches undergoing unilateral total mastectomy.

The aim of this study was to evaluate the latency, extent of analgesia, and duration of motor block of levobupivacaine alone and combined with methadone or dexmedetomidine after epidural administration during and after mastectomy in dogs. Twenty-four mature, mixed-breed female dogs were randomly divided into three experimental groups with eight animals each, according to the agents used in lumbosacral epidural analgesia: levobupivacaine 0.75% alone (1.5mg/kg - control group), levobupivacaine 0.75% (1.5 mg/kg) + methadone 1% (0.3 mg/kg), or levobupivacaine 0.75% (1.5 mg/kg) + dexmedetomidine 0.05% (3 µg/kg). During surgery, cardiorespiratory parameters were evaluated. Rescue analgesia was given when there were signs of nociception and was necessary in all three treatment groups. Since all animals received rescue analgesia during the surgery and immediately post-surgery, the duration of the sensitive block were not evaluated. The extent of sensory block was between the 12º and 13º thoracic vertebrae for the control group, 7º thoracic vertebra to 5º lumbar vertebra (methadone group), and 8º thoracic vertebra to 4º lumbar vertebra for the dexmedetomidine group. Methadone or dexmedetomidine combined with levobupivacaine increased the extent of the sensory block and the duration of the motor block in bitches when administered via the epidural route.

Associação do bloqueio do plano transverso e serrátil em gata submetida à mastectomia / Association of transversus and serratus plane block in cat submitted to mastectomy

Os bloqueios locorregionais são considerados padrão-ouro para a analgesia perioperatória. Sendo assim, este trabalho apresenta o efeito da associação do bloqueio do plano transverso do abdome com o bloqueio do plano serrátil em um felino de 11 anos, fêmea, que foi submetido à mastectomia unilateral. Foi utilizada a metadona 0,3 mg/kg via intramuscular (IM) na medicação pré-anestésica e propofol dose-efeito via intravenosa (IV) para indução, enquanto a manutenção foi feita com isoflurano. O TAP Block e o SP-Block foram realizados unilateralmente utilizando a associação de bupivacaína 0,3mL/kg, em cada ponto, diluída a 0,25% com solução fisiológica. A frequência cardíaca (FC), a frequência respiratória (f), a pressão arterial não invasiva (Método Doppler), a temperatura esofágica (oC), a saturação de oxigênio (SpO2), a capnografia (EtCO2) e o eletrocardiograma foram monitorados continuamente e registrados a cada dez minutos. A paciente foi monitorada por cinco horas, após a extubação, quanto à dor, sendo utilizada, para isso, a Escala Multidimensional de Dor Aguda (UNESP-Botucatu). A recuperação anestésica da paciente foi rápida e sem complicações. Durante a avaliação de dor, o animal apresentou escore zero, não manifestando qualquer desconforto pós-operatório. A associação das técnicas foi eficaz no bloqueio anestésico das paredes torácica e abdominal, sugerindo a inclusão destas nos protocolos de analgesia multimodal para esse tipo de cirurgia.

Locoregional blocks are considered the gold standard for perioperative analgesia. Thus, this paper presents the effect of the association of transverse abdominal plane block with serratus plane block in an 11-year-old female feline submitted to unilateral mastectomy. Methadone 0.3 mg/kg via intramuscular (IM) was used as pre anesthetic medication and dose-effect propofol via intravenous (IV) was used for induction, while the maintenance was done with isofluorane. TAP Block and SP-Block were performed unilaterally using an association of Bupivacaine 0.3 ml/kg at each point, diluted to 0.25% with saline solution. Heart rate (HR), respiratory rate (f), non-invasive blood pressure (Doppler method), esophageal temperature (oC), oxygen saturation (SpO2), capnography (EtCO2), and electrocardiogram were monitored continuously and recorded every 10 minutes. The patient was monitored for pain during five hours after extubation using the Multidimensional Scale of UNESP-Botucatu. The anesthetic recovery of the patient was fast and without complications. During pain assessment, the animal presented a score of zero and did not present any postoperative discomfort. The association of techniques was effective in the anesthetic blockade of the thoracic and abdominal walls, suggesting their inclusion in multimodal analgesia protocols for this type of surgery.

Effects of heated tumescence solution in bitches after unilateral mastectomy

Background: Mammary tumors, for which mastectomy is the main treatment, are the most common neoplasms in bitches. Mastectomy is painful and, in order to reduce the pain stimulus in the transoperative period, tumescent local anesthesia is associated with general inhalation anesthesia. However, despite the numerous benefits of tumescence, intraoperative hypothermia is the most common complication. In Medicine, especially in plastic and dermatological surgery, it is common to use a heated tumescence solution to prevent intraoperative hypothermia; however, in Veterinary medicine, no previous study has examined the advantages and disadvantages of using heated tumescence solution. Thus, this study aimed to investigate the transanesthetic cardiorespiratory effects of heated tumescence solution in bitches submitted to radical unilateral mastectomy. Materials, Methods & Results: Eight animals were treated with 0.1% lidocaine solution, warmed to 37-42°C, using a Kleins cannula for administration. Chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) were used as pre-anesthetic medication intramuscularly, and induction was performed with intravenous propofol and maintenance with isoflurane. The data collection times were as follows: 15 min after starting isoflurane administration (M1), 5 min after tumescence (M2), after beginning of surgical incision (M3), during breast pullout (M4), after clamping of the superficial caudal epigastric vein, and artery (M5), after the beginning of the approximation of the subcutaneous tissue (M6), after the beginning of the intradermal suture (M7), and at the end of the surgical procedure (Mfinal). The heart...(AU)

Locoregional anesthesia due to tumescence in bilateral total mastectomy of goats

Background: Mastitis is an inflammation of the mammary gland or udder, regardless of its origin, severity, or evolution. Bilateral total mastectomy is indicated in cases of chronic suppurative mastitis, gangrenous mastitis, udder neoplasm or hyperplasia. For mastectomy, the supine position is recommended and, as it is a long-term procedure, general anesthesia was chosen together with the tumescence technique with the objective of transanesthetic and postoperative analgesia. The present report aims to report the general anesthesia protocol used for 2 goats submitted to bilateral total mastectomy associated with a locoregional block by tumescence, a technique not described in the goat species. Cases: Two female goats, mixed breed, approximately 3 years old, were admitted to the Hospital Veterinário de Grandes Animais (HVGA) of the Universidade Federal Rural do Rio de Janeiro (UFRRJ), with a history of recurrent mastitis. There was an increase in udder volume and the presence of purulent secretion during milking. One of the animals had given birth about 20 days ago. Surgical treatment through bilateral total mastectomy was recommended for both animals, as they did not present a satisfactory response to antimicrobial therapy, excessive enlargement and functional loss of the mammary system. For the procedure, food fasting for 48 h and water fasting for 24 h was established. The anesthetic protocols used consisted of previous sedation with xylazine1 [Xilazin® - 0.05 mg/kg, IM] anesthetic induction with ketamine2 [Ketalex® - 10 mg/kg, IV] and midazolam3 [Dormire® - 0.1 mg/kg, IV]. Orotracheal intubation and connection to the anesthetic circuit were performed for maintenance through inhalation anesthesia with isoflurane4 (Forane®) and oxygen therapy. Then, in bottle of lactated ringer's solution5 [Linhamax® - 500 mL], lidocaine 2%6 without vasoconstrictor [Lidovet® - 40 mL] and adrenaline7 [Adren® - 25 mg/mL, 0.5 mL] were added, 10 mL/kg of the solution were injected into the subcutaneous tissue of the region of the mammary chains utilizing a Klein cannula after local antisepsis. After the administration of the tumescent solution, it was observed that the area involved is presented with the formation of a gel and there is minimal bleeding, compared to the conventional technique. The animals were monitored for the degree of analgesia, recording vital signs every 15 min at the end of the surgery, dipyrone9 [D-500® - 25 mg/kg, IV], morphine7 [Sulfato de Morfina® - 0.1 mg/kg, SC], and meloxicam10 [Maxican® 0.5 mg/kg, IM, 3 consecutive days] for postoperative analgesia. Additionally, tetanus serum1 [Vencosat® - 50,000 IU, single dose] and of oxytetracycline¹ [Oxitetraciclina LA® - 10 mg/kg, IM, 5 applications on alternate days)]. In the following 24 h, no signs of pain were observed on palpation of the surgical wound in the animals, but goat 1 was apathetic and inappetent, with improvement in the clinical picture only 48 h after surgery. Discussion: The choice of the surgical procedure resulted in an improvement in the clinical conditions of the animals and the anesthetic protocol using inhalation anesthesia and locoregional block (tumescence) proved to be efficient to perform in goats, contributing to transanesthetic and postoperative analgesia, being easily applied to ruminants that need surgical interventions in the region of mammary chains.

Effects of heated tumescence solution in bitches after unilateral mastectomy

Background: Mammary tumors, for which mastectomy is the main treatment, are the most common neoplasms in bitches. Mastectomy is painful and, in order to reduce the pain stimulus in the transoperative period, tumescent local anesthesia is associated with general inhalation anesthesia. However, despite the numerous benefits of tumescence, intraoperative hypothermia is the most common complication. In Medicine, especially in plastic and dermatological surgery, it is common to use a heated tumescence solution to prevent intraoperative hypothermia; however, in Veterinary medicine, no previous study has examined the advantages and disadvantages of using heated tumescence solution. Thus, this study aimed to investigate the transanesthetic cardiorespiratory effects of heated tumescence solution in bitches submitted to radical unilateral mastectomy. Materials, Methods & Results: Eight animals were treated with 0.1% lidocaine solution, warmed to 37-42°C, using a Klein’s cannula for administration. Chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) were used as pre-anesthetic medication intramuscularly, and induction was performed with intravenous propofol and maintenance with isoflurane. The data collection times were as follows: 15 min after starting isoflurane administration (M1), 5 min after tumescence (M2), after beginning of surgical incision (M3), during breast pullout (M4), after clamping of the superficial caudal epigastric vein, and artery (M5), after the beginning of the approximation of the subcutaneous tissue (M6), after the beginning of the intradermal suture (M7), and at the end of the surgical procedure (Mfinal). The heart...

Ginecomastia: Consideraciones médicas y quirúrgicas en cirugía general / Gynecomastia: Medical and surgical considerations in general surgery

La ginecomastia, definida como el crecimiento del tejido glandular mamario en los hombres, aparece desde la etapa neonatal hasta la senil, puede ser unilateral o bilateral, y es de causa multifactorial, incluyendo aquellos pacientes asociados al uso de medicamentos, donde predomina un desbalance en la relación testosterona­estrógeno. Relativamente, la idiopática es la más frecuente. La mayoría involucionan espontáneamente, las neonatales por perdida del influjo transplacentario en las primeras semanas, y las puberales entre 12 a 24 meses. Se presenta como un aumento del tamaño mamario, asintomático o con hipersensibilidad por inflamación durante el crecimiento del tejido fibroglandular mamario, con una repercusión psicológica enorme, sobre todo en la etapa de la adolescencia. El estudio y manejo es interdisciplinario y se ofrece de acuerdo con las condiciones y la etiología. Aquellos pacientes púberes en quienes no involuciona reciben tratamientos médicos, o tratamientos quirúrgicos cuando falla la terapéutica o hay presión social, e incluso radioterapia en casos donde desarrollan ginecomastia con hipersensibilidad al tratamiento hormonal del cáncer de próstata

Gynecomastia, defined as the growth of breast glandular tissue in men, appears from the neonatal to senile stage, can be unilateral or bilateral, and is of multifactorial cause, including those patients associated with the use of medications, where an imbalance in the testosterone ­ estrogen ratio. Relatively, idiopathic is the most common. Most regress spontaneously, neonatals due to loss of transplacental influx in the first weeks, and pubertal ones between 12 to 24 months. It presents as an increase in breast size, asymptomatic or with hypersensitivity due to inflammation during the growth of the mammary fibroglandular tissue, with an enormous psychological repercussion, especially in adolescence. The study and management is interdisciplinary and offered according to conditions and etiology. Those pubertal patients in whom it does not regress receive medical treatments, or surgical treatments when therapy fails or there is social pressure, and even radiotherapy in cases where they develop gynecomastia with hypersensitivity to hormonal treatment of prostate cancer

Breast-conserving surgery vs. total mastectomy in patients with triple negative breast cancer in early stages: A propensity score analysis.

BACKGROUND: Breast-conserving surgery (BCS) as an alternative to total mastectomy (TM) in patients with early-stage triple-negative breast cancer (TNBC) is not widely spread. OBJECTIVE: We aimed to compare the overall survival (OS) and disease-free survival (DFS) between both surgical approaches in early-stage TNBC patients at 10 years. METHODS: We conducted a retrospective cohort study in TNBC female patients with stage I-IIa, treated at a single-center during the period of 2000-2014. We estimated and compared the survival rates with the Kaplan Meier and Long-rank test. Propensity scores were calculated with the generalized boosted regression model and were used in the multivariate Cox regression analysis with the covariate adjustment method. RESULTS: We included 288 patients, 111 in the BCS vs. 177 in the TM group. The median follow-up was 102 months. Moreover, the patients in the BCS group had superior OS (85% vs. 81%, p = 0.56) and DFS (83% vs. 80%, p = 0.42) at 10 years. In the multivariate Cox analysis, BCS decreased the mortality risk (HR: 0.79, 95% CI: 0.37-1.67, p = 0.538), and the locoregional or distant recurrence risk (HR: 0.67, 95% CI: 0.32-1.41, p = 0.294), albeit with no statistical significance. CONCLUSION: BCS is a safe alternative to TM in Latin-American patients with early-stage TNBC.

Eletrocardiografia em cadelas submetidas à mastectomia unilateral total / Electrocardiogram in bitches submitted to unilateral total mastectomy

Background: The frequency of oncological diseases in companion animals has increased in recent years, mainly due tothe longer longevity of dogs. The neoplasms are not only open by the presence of the tumor and its location, but also byparaneoplastic syndromes, which are disorders that occur due to the production of substances by the tumor that cause.In addition to causing local changes and damages, oncological diseases may also result in injuries at distant sites, suchas paraneoplastic syndromes, which, if untreated, may result in death of animals. The present study aimed to investigatewhether female dogs with mammary tumors demonstrate electrocardiographic changes, and if so, to investigate whetherthese cease after removal of the tumor, and to relate the type of tumor with the occurrence of arrhythmias.Materials, Methods & Results: Eighteen female dogs, aged between 4 and 14 years, underwent electrocardiogram 24 hprior to undergoing a total unilateral mastectomy. After removal of the tumor, electrocardiograms were again performed 24(M24), 48 (M48), and 72 (M72), as well as 14 days (M14d) after surgery. Histological analysis of the neoplasms showedthat 55% of the tumors were benign, with predominance of adenoma (38%), and 45% were malignant, with predominanceof adenocarcinoma (22%). The following rhythms and arrhythmias were observed: normal sinus rhythm (37.2%), sinusarrhythmia (62.8%), wandering pacemaker (26%), 1st degree atrioventricular block (AVB; 5%), premature ventricularcomplex (PVC; 10%), and T-wave > 25% of R-wave (25%); more than one change could occur simultaneously. Out of theevaluated electrocardiographic parameters, a significant difference was observed in the QT interval between the followingtimepoints: M24 (204 ± 18), M48 (204 ± 22), and M72 (203 ± 23), as well as Mbasal (192 ± 15) and M14d (178 ± 43).Discussion: Regarding the observed rhythms, arrhythmias, and changes, respiratory sinus arrhythmia was the normal predominant...

Eletrocardiografia em cadelas submetidas à mastectomia unilateral total / Electrocardiogram in bitches submitted to unilateral total mastectomy

Background: The frequency of oncological diseases in companion animals has increased in recent years, mainly due tothe longer longevity of dogs. The neoplasms are not only open by the presence of the tumor and its location, but also byparaneoplastic syndromes, which are disorders that occur due to the production of substances by the tumor that cause.In addition to causing local changes and damages, oncological diseases may also result in injuries at distant sites, suchas paraneoplastic syndromes, which, if untreated, may result in death of animals. The present study aimed to investigatewhether female dogs with mammary tumors demonstrate electrocardiographic changes, and if so, to investigate whetherthese cease after removal of the tumor, and to relate the type of tumor with the occurrence of arrhythmias.Materials, Methods & Results: Eighteen female dogs, aged between 4 and 14 years, underwent electrocardiogram 24 hprior to undergoing a total unilateral mastectomy. After removal of the tumor, electrocardiograms were again performed 24(M24), 48 (M48), and 72 (M72), as well as 14 days (M14d) after surgery. Histological analysis of the neoplasms showedthat 55% of the tumors were benign, with predominance of adenoma (38%), and 45% were malignant, with predominanceof adenocarcinoma (22%). The following rhythms and arrhythmias were observed: normal sinus rhythm (37.2%), sinusarrhythmia (62.8%), wandering pacemaker (26%), 1st degree atrioventricular block (AVB; 5%), premature ventricularcomplex (PVC; 10%), and T-wave > 25% of R-wave (25%); more than one change could occur simultaneously. Out of theevaluated electrocardiographic parameters, a significant difference was observed in the QT interval between the followingtimepoints: M24 (204 ± 18), M48 (204 ± 22), and M72 (203 ± 23), as well as Mbasal (192 ± 15) and M14d (178 ± 43).Discussion: Regarding the observed rhythms, arrhythmias, and changes, respiratory sinus arrhythmia was the normal predominant... (AU)

Reconstrução mamária com implantes e tela sintética / Breast reconstruction with implants and synthetic mesh

Introdução: As mastectomias com reconstruções mamárias imediatas podem proteger a paciente de um período de estresse psicossocial, imagem corporal negativa e insatisfação sexual. O advento e utilização de novos materiais como os implantes, expansores e matrizes dérmicas acelulares também contribuíram para o sucesso das reconstruções mamárias. Porém, o uso das matrizes dérmicas acelulares é restrito no Brasil pela legislação e seu alto custo. O objetivo do estudo foi relatar a experiência do autor na reconstrução mamária com implantes e tela sintética como uma alternativa às matrizes dérmicas acelulares. Método: Foi realizada uma análise retrospectiva de 12 pacientes consecutivas (20 mamas reconstruídas) que foram submetidas à reconstrução mamária imediata ou tardia pela técnica descrita com implantes e tela sintética, entre novembro de 2015 e dezembro de 2016. Resultados: Doze pacientes (20 mamas) foram operadas pela técnica apresentada no estudo. O tempo médio de follow-up foi de 14 meses. Nesta série, 15% apresentaram complicações menores como hematoma, deiscência de sutura e rippling. O número de complicações, apesar do número restrito de casos, é compatível com a literatura. O grau de satisfação global com a cirurgia foi, em média, de 75,2 pontos em uma escala de 0-100, sendo a nota mais alta atribuída à aparência das mamas (85 pontos). Conclusão: A reconstrução mamária com implantes e tela sintética se mostrou uma técnica com baixo índice de complicações, alto grau de satisfação das pacientes com o resultado estético e com menores custos em relação ao uso de matrizes dérmicas acelulares.

Introduction: Mastectomy with immediate breast reconstruction may prevent patients from experiencing a period of psychosocial stress, negative body image, and sexual dissatisfaction. The advent and implementation of novel materials such as implants, expanders, and acellular dermal matrices have also contributed to the success of breast reconstruction procedures. However, the use of acellular dermal matrices in Brazil is restricted by law and by their high cost. The objective of the present study was to report the author's experience in breast reconstruction with implants and synthetic mesh as an alternative to acellular dermal matrices. Method: This was a retrospective analysis of 12 consecutive patients (20 reconstructed breasts) who underwent immediate or delayed breast reconstruction using the described technique with implants and synthetic mesh between November 2015 and December 2016. Results: Twelve patients (20 breasts) were operated on using the technique described in this report. The mean time of follow-up was 14 months. In this series, 15% of patients had minor complications, including hematoma, suture dehiscence, and rippling. The rate of complications was similar to the rates reported in the literature, despite the limited number of cases. The average degree of overall satisfaction with the surgery was 75.2 points on a scale of 0-100, and the highest score was given to breast appearance (85 points). Conclusion: Breast reconstruction with implants and synthetic mesh was shown to be a technique with a low rate of complications, high degree of patient satisfaction with the cosmetic result, and decreased cost relative to acellular dermal matrices.

Agenesia unilateral del cuerno uterino y ovario derecho de gato: un informe de caso / Unilateral agenesis of the uterine horn and right ovary in cat: a case report / Agenesia unilateral do corno uterino e ovário direito em gata: relato de caso

El objetivo fue describir el hallazgo de agenesia uterina y ovárica en gata sometida a procedimiento para la mastectomía total de ovariohisterectomía y el tratamiento de la hiperplasia mamaria felina fibroepitelial. En este artículo se describe el caso de un felino, femenino, sin raza definida, de siete meses de edad con histórico de hinchazón de las mamas después de la administración de una dosis de anticonceptivos de acetato de medroxiprogesterona. De acuerdo con la historia clínica y el examen físico establecido el diagnóstico de la hiperplasia fibroepitelial felina. Para el tratamiento era la mastectomía completa y ovariohisterectomía (OSH). Durante la cirugía se comprobó la ausencia del cuerno uterino y ovario derecho. Este tipo de defecto puede pasar desapercibido porque los animales pueden no mostrar clínica y mostrar un comportamiento estral regular, siendo en su mayoría incidental encontrar y asume importancia, especialmente para la posibilidadde la aparición de diversas anomalías órganos con el mismo origen embriológico.(AU)

This study aimed to describe the finding of uterine and ovarian agenesis in cat after a total mastectomy procedure and ovariosalpingohisterectomy for treatment of feline mammary fibroepithelial hyperplasia. This paper described the case of a feline, female, without defined breed standard, seven months of age, it presented description of increase of mammary volume, after the administration of a dose of contraceptive medroxyprogesterone acetate. According to medical history and physical examination the diagnosis of feline fibroepithelial hyperplasia was established. For the treatment was opted to realize a complete mastectomy and ovaryhysterectomy (OSE). During the surgery was found the absence of the horn uterine and right ovary. This type of defect can go undetected since the animal may not present clinical and demonstrate the normal estrous behavior, and most often an incidental finding and assumes importance, especially for the possibility of the occurrence of various organs anomalies with the same origin embryological.(AU)

Objetivou-se descrever o achado de agenesia uterina e ovariana em gata submetida a procedimento de mastectomia total e ovariosalpingohisterectomia para tratamento de hiperplasia fibroepitelial mamária felina. O presente trabalho descreveu o caso de um felino, fêmea, sem padrão de raça definido, sete meses de idade com histórico de aumento de volume mamário após administração de uma dose de contraceptivo acetato de medroxiprogesterona. De acordo com a anamnese e o exame físico foi estabelecido o diagnóstico de hiperplasia fibroepitelial felina. Para o tratamento foi instituído a mastectomia total e a ovariosalpingohisterectomia (OSH). Durante o ato operatório constatou-se a ausência do corno uterino e ovário direito. Esse tipo de malformação pode passar despercebido já que o animal pode não apresentar alterações clínicas e demonstrar comportamento éstrico normal, sendo na maioria das vezes um achado incidental e assume importância, principalmente, pela possiblidade da ocorrência de anomalias de órgãos distintos com a mesma origem embriológica.(AU)

Agenesia unilateral del cuerno uterino y ovario derecho de gato: un informe de caso / Unilateral agenesis of the uterine horn and right ovary in cat: a case report / Agenesia unilateral do corno uterino e ovário direito em gata: relato de caso

El objetivo fue describir el hallazgo de agenesia uterina y ovárica en gata sometida a procedimiento para la mastectomía total de ovariohisterectomía y el tratamiento de la hiperplasia mamaria felina fibroepitelial. En este artículo se describe el caso de un felino, femenino, sin raza definida, de siete meses de edad con histórico de hinchazón de las mamas después de la administración de una dosis de anticonceptivos de acetato de medroxiprogesterona. De acuerdo con la historia clínica y el examen físico establecido el diagnóstico de la hiperplasia fibroepitelial felina. Para el tratamiento era la mastectomía completa y ovariohisterectomía (OSH). Durante la cirugía se comprobó la ausencia del cuerno uterino y ovario derecho. Este tipo de defecto puede pasar desapercibido porque los animales pueden no mostrar clínica y mostrar un comportamiento estral regular, siendo en su mayoría incidental encontrar y asume importancia, especialmente para la posibilidadde la aparición de diversas anomalías órganos con el mismo origen embriológico.

This study aimed to describe the finding of uterine and ovarian agenesis in cat after a total mastectomy procedure and ovariosalpingohisterectomy for treatment of feline mammary fibroepithelial hyperplasia. This paper described the case of a feline, female, without defined breed standard, seven months of age, it presented description of increase of mammary volume, after the administration of a dose of contraceptive medroxyprogesterone acetate. According to medical history and physical examination the diagnosis of feline fibroepithelial hyperplasia was established. For the treatment was opted to realize a complete mastectomy and ovaryhysterectomy (OSE). During the surgery was found the absence of the horn uterine and right ovary. This type of defect can go undetected since the animal may not present clinical and demonstrate the normal estrous behavior, and most often an incidental finding and assumes importance, especially for the possibility of the occurrence of various organs anomalies with the same origin embryological.

Objetivou-se descrever o achado de agenesia uterina e ovariana em gata submetida a procedimento de mastectomia total e ovariosalpingohisterectomia para tratamento de hiperplasia fibroepitelial mamária felina. O presente trabalho descreveu o caso de um felino, fêmea, sem padrão de raça definido, sete meses de idade com histórico de aumento de volume mamário após administração de uma dose de contraceptivo acetato de medroxiprogesterona. De acordo com a anamnese e o exame físico foi estabelecido o diagnóstico de hiperplasia fibroepitelial felina. Para o tratamento foi instituído a mastectomia total e a ovariosalpingohisterectomia (OSH). Durante o ato operatório constatou-se a ausência do corno uterino e ovário direito. Esse tipo de malformação pode passar despercebido já que o animal pode não apresentar alterações clínicas e demonstrar comportamento éstrico normal, sendo na maioria das vezes um achado incidental e assume importância, principalmente, pela possiblidade da ocorrência de anomalias de órgãos distintos com a mesma origem embriológica.

Enfermedad de Paget de la mama en una paciente suazí / Paget´s disease of the breast in a suazi patient

Se describe el caso clínico de una paciente de 63 años de edad, quien acudió a la consulta de Oncología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión ulcerada en el pezón de la mama izquierda desde hacía 1 año. Luego de realizarle una biopsia por escisión, que reveló la presencia de la enfermedad de Paget, clasificada en el estadio 0 según los resultados de los exámenes complementarios, se decidió remitirla al Servicio de Cirugía donde le practicaron una mastectomía simple. La paciente mostró buena evolución clínica y se mantenía estable hasta la última consulta en que fuera asistida

The case report of a 63 years patient who went to the Oncology Service of the Government Hospital of Mbabane, in Swaziland is described, due to an ulcerated lesion in the nipple of the left breast for 1 year. After carrying out an excision biopsy that revealed the presence of the Paget´s disease, classified in the stage 0 according to the results of the complementary tests, she was referred to the Surgery Service where a simple mastectomy was carried out. The patient showed good clinical course and she remained stable until the last appointment when she was assisted

Correlação entre as escalas analógica visual, de Glasgow, Colorado e Melbourne na avaliação de dor pós-operatória em cadelas submetidas à mastectomia total unilateral / Correlation between visual analog scales, Glasgow, Colorado and Melbourne in the evaluation of postoperative pain in dogs undergoing total unilateral mastectomy

Objetivou-se correlacionar a necessidade de resgate analgésico pós-operatório por meio das escalas analógica visual (EVA), de Glasgow, Colorado e Melbourne, por meio de um avaliador experiente (AE) e outro não experiente (ANE), em cadelas submetidas à mastectomia unilateral total. Foram utilizadas 24 cadelas, hígidas, internadas 24 horas antes do procedimento cirúrgico, para avaliação do seu comportamento, com o auxílio das escalas descritas acima no momento basal (M0). Foram pré-medicadas com acepromazina e morfina (0,02 e 0,5mg/kg) e induzidas à anestesia geral com propofol (4mg/kg), mantidas em plano anestésico com CAM de isoflurano 1%. A manutenção analgésica transoperatória foi realizada com cetamina e fentanil (10µg/kg/min e 10µg/kg/h). As demais avaliações ocorreram em uma, duas, quatro, seis, oito, 12 e 24 horas de pós-operatório, sendo os resgates realizados com morfina (0,5mg/kg), pela via intramuscular, quando fosse observada uma pontuação maior ou igual a 50, seis, dois e nove pontos, respectivamente, para as escalas descritas, quando observada pelo AE e quando ao menos duas das escalas demonstrassem esses valores. Houve aumento dos escores de dor do M1 ao M12 para o AE e para o ANE para a EVA. Na análise de Colorado, maiores pontuações de dor ocorreram em relação ao M0 entre o M2 e o M8 para o AE e do M1 ao M12 para o ANE. Na análise de Glasgow, maiores escores foram detectados entre o M1 e o M12 para o AE e do M1 ao M24 para o ANE. E para a de Melbourne, maiores valores foram observados do M1 e do M24 para o AE e o ANE. A melhor correlação entre as escalas foi de 0,775 entre Glasgow e Colorado e entre os avaliadores de 0,925 para a Glasgow. Conclui-se que a escala de Glasgow apresentou-se mais sensível para detectar resgates analgésicos em cadelas submetidas à mastectomia total unilateral, que a inexperiência do avaliador não compromete a qualidade das avaliações de dor e sugere-se reduzir a pontuação da EVA e Melbourne para aumentar a sua capacidade em detectar resgates analgésicos pós-operatórios.(AU)

The objective was to relate the need for analgesic postoperative recovery through Visual Analogue Scale (VAS), Glasgow, Colorado and Melbourne, by an experienced assessor (AE) and other non-experienced ones (ANE), in bitches undergoing total unilateral mastectomy. Otherwise healthy bitches, a total of 24, were admitted 24 hours before the surgical procedure for assessment of behavior with the help of the above scales to determine the baseline (M0) moment. They were pre-medicated with morphine and acepromazine (0,02 and 0,5 mg/kg) and general anesthesia was induced with propofol (4 mg/kg) and maintained with isoflurane at 1% MAC. The analgesic during surgery was maintained with ketamine and fentanyl (10 µg/kg/min and 10 µg/kg/h). The other evaluations were performed at 1, 2, 4, 6, 8, 12 and 24 hours postoperatively, and redemptions made with intramuscular morphine (0,5 mg/kg) when a greater than or equal score of 50, 6, 2 and 9 points was observed respectively for the described ranges, as observed by the AE and when at least two scales demonstrated these values. There was an increase of M1 to M12 pain scores for AE and the ANE for VAS. In Colorado analyses, the highest painful scores occurred in relation to M0 between M2 and M8 to the AE and M1 to M12 for ANE. In Glasgow analyses, higher scores were detected between M1 to M12 for AE and M1 to M24 for ANE. And for the Melbourne highest values were observed in M1 and M24 for AE and ANE. The best correlation between the scales was 0,775 between Glasgow and Colorado and of the evaluators of 0,925 to Glasgow. The Glasgow scale was shown to be more sensitive to detect painkiller redemptions in dogs undergoing total unilateral mastectomy, the inexperience of the appraiser does not compromise the quality of painful reviews, and it is suggested to reduce the score VAS and Melbourne to increase it is ability to detect rescue postoperative analgesics.(AU)

Correlação entre as escalas analógica visual, de Glasgow, Colorado e Melbourne na avaliação de dor pós-operatória em cadelas submetidas à mastectomia total unilateral / Correlation between visual analog scales, Glasgow, Colorado and Melbourne in the evaluation of postoperative pain in dogs undergoing total unilateral mastectomy

Objetivou-se correlacionar a necessidade de resgate analgésico pós-operatório por meio das escalas analógica visual (EVA), de Glasgow, Colorado e Melbourne, por meio de um avaliador experiente (AE) e outro não experiente (ANE), em cadelas submetidas à mastectomia unilateral total. Foram utilizadas 24 cadelas, hígidas, internadas 24 horas antes do procedimento cirúrgico, para avaliação do seu comportamento, com o auxílio das escalas descritas acima no momento basal (M0). Foram pré-medicadas com acepromazina e morfina (0,02 e 0,5mg/kg) e induzidas à anestesia geral com propofol (4mg/kg), mantidas em plano anestésico com CAM de isoflurano 1%. A manutenção analgésica transoperatória foi realizada com cetamina e fentanil (10µg/kg/min e 10µg/kg/h). As demais avaliações ocorreram em uma, duas, quatro, seis, oito, 12 e 24 horas de pós-operatório, sendo os resgates realizados com morfina (0,5mg/kg), pela via intramuscular, quando fosse observada uma pontuação maior ou igual a 50, seis, dois e nove pontos, respectivamente, para as escalas descritas, quando observada pelo AE e quando ao menos duas das escalas demonstrassem esses valores. Houve aumento dos escores de dor do M1 ao M12 para o AE e para o ANE para a EVA. Na análise de Colorado, maiores pontuações de dor ocorreram em relação ao M0 entre o M2 e o M8 para o AE e do M1 ao M12 para o ANE. Na análise de Glasgow, maiores escores foram detectados entre o M1 e o M12 para o AE e do M1 ao M24 para o ANE. E para a de Melbourne, maiores valores foram observados do M1 e do M24 para o AE e o ANE. A melhor correlação entre as escalas foi de 0,775 entre Glasgow e Colorado e entre os avaliadores de 0,925 para a Glasgow. Conclui-se que a escala de Glasgow apresentou-se mais sensível para detectar resgates analgésicos em cadelas submetidas à mastectomia total unilateral, que a inexperiência do avaliador não compromete a qualidade das avaliações de dor e sugere-se reduzir a [...](AU)

The objective was to relate the need for analgesic postoperative recovery through Visual Analogue Scale (VAS), Glasgow, Colorado and Melbourne, by an experienced assessor (AE) and other non-experienced ones (ANE), in bitches undergoing total unilateral mastectomy. Otherwise healthy bitches, a total of 24, were admitted 24 hours before the surgical procedure for assessment of behavior with the help of the above scales to determine the baseline (M0) moment. They were pre-medicated with morphine and acepromazine (0,02 and 0,5 mg/kg) and general anesthesia was induced with propofol (4 mg/kg) and maintained with isoflurane at 1% MAC. The analgesic during surgery was maintained with ketamine and fentanyl (10 µg/kg/min and 10 µg/kg/h). The other evaluations were performed at 1, 2, 4, 6, 8, 12 and 24 hours postoperatively, and redemptions made with intramuscular morphine (0,5 mg/kg) when a greater than or equal score of 50, 6, 2 and 9 points was observed respectively for the described ranges, as observed by the AE and when at least two scales demonstrated these values. There was an increase of M1 to M12 pain scores for AE and the ANE for VAS. In Colorado analyses, the highest painful scores occurred in relation to M0 between M2 and M8 to the AE and M1 to M12 for ANE. In Glasgow analyses, higher scores were detected between M1 to M12 for AE and M1 to M24 for ANE. And for the Melbourne highest values were observed in M1 and M24 for AE and ANE. The best correlation between the scales was 0,775 between Glasgow and Colorado and of the evaluators of 0,925 to Glasgow. The Glasgow scale was shown to be more sensitive to detect painkiller redemptions in dogs undergoing total unilateral mastectomy, the inexperience of the appraiser does not compromise the quality of painful reviews, and it is suggested to reduce the score VAS and Melbourne to increase it is ability to detect rescue postoperative analgesics.(AU)

Avaliação de dois protocolos de analgesia transoperatória em cadelas submetidas à mastectomia unilateral total / Evaluation of two protocols for analgesia during total unilateral mastectomy in bitches

Background: Proper evaluation of pain is essential to select effective anesthetic protocols in surgical procedures in animals. Pain assessment can be accomplished during the perioperative period by measuring several physiological parameters, such as heart and respiratory rates. Measuring serum levels of cortisol and glucose is one of the most commonly used methods to assess the effectiveness of protocols for pain control. The aim of this study was to compare two analgesic protocols in dogs undergoing unilateral total mastectomy, a surgery that can cause moderate-to-severe pain in dogs. Materials, Methods & Results: Eighteen female dogs seen at the Veterinary Hospital of the University of Southern Santa Catarina, Brazil, were recruited for this study, without stratification by breed and age, except for brachycephalic breeds. The animals were divided into two groups: 1) FLK group, in which the animals received preoperative ketamine (5 mg/ kg, IM) and midazolam (0.3 mg/kg, IM), an IV bolus of fentanyl (0.004 mg/kg), lidocaine (2 mg/kg) and ketamine (0.5 mg/kg), and then a combination of fentanyl (0.008 mg/kg/h), ketamine (0.6 mg/kg/h) and lidocaine (2 mg/kg/h) diluted in normal saline solution were infused at a rate of 10 mL/kg/h until the end of the surgical procedure; 2) AM group, in which the animals received preoperative morphine (0.5 mg/kg, IM) and acepromazine (0.05 mg/kg, IM). In both groups, anesthesia was induced by using propofol (6 mg/kg, IV) and maintained with isoflurane. Blood samples were collected by jugular venipuncture (4 mL) in the preoperative and postoperative periods to evaluate serum levels of cortisol and glucose. Statistical analysis was carried out using the two-way analysis of variance (ANOVA) for repeated measures, followed by the Tukey test (P < 0.05). […]

Avaliação de dois protocolos de analgesia transoperatória em cadelas submetidas à mastectomia unilateral total / Evaluation of two protocols for analgesia during total unilateral mastectomy in bitches

Background: Proper evaluation of pain is essential to select effective anesthetic protocols in surgical procedures in animals. Pain assessment can be accomplished during the perioperative period by measuring several physiological parameters, such as heart and respiratory rates. Measuring serum levels of cortisol and glucose is one of the most commonly used methods to assess the effectiveness of protocols for pain control. The aim of this study was to compare two analgesic protocols in dogs undergoing unilateral total mastectomy, a surgery that can cause moderate-to-severe pain in dogs. Materials, Methods & Results: Eighteen female dogs seen at the Veterinary Hospital of the University of Southern Santa Catarina, Brazil, were recruited for this study, without stratification by breed and age, except for brachycephalic breeds. The animals were divided into two groups: 1) FLK group, in which the animals received preoperative ketamine (5 mg/ kg, IM) and midazolam (0.3 mg/kg, IM), an IV bolus of fentanyl (0.004 mg/kg), lidocaine (2 mg/kg) and ketamine (0.5 mg/kg), and then a combination of fentanyl (0.008 mg/kg/h), ketamine (0.6 mg/kg/h) and lidocaine (2 mg/kg/h) diluted in normal saline solution were infused at a rate of 10 mL/kg/h until the end of the surgical procedure; 2) AM group, in which the animals received preoperative morphine (0.5 mg/kg, IM) and acepromazine (0.05 mg/kg, IM). In both groups, anesthesia was induced by using propofol (6 mg/kg, IV) and maintained with isoflurane. Blood samples were collected by jugular venipuncture (4 mL) in the preoperative and postoperative periods to evaluate serum levels of cortisol and glucose. Statistical analysis was carried out using the two-way analysis of variance (ANOVA) for repeated measures, followed by the Tukey test (P < 0.05). […](AU)

MRI to Predict Nipple Involvement in Breast Cancer Patients.

OBJECTIVE: The selection of breast cancer patients as candidates for nipple-sparing mastectomy (NSM) is dependent on the preoperative detection of neoplastic involvement of the nipple-areola complex (NAC). This cross-sectional study was designed to evaluate the accuracy of preoperative breast MRI as a noninvasive method to predict neoplastic involvement of the nipple. MATERIALS AND METHODS: We included 165 female breast cancer patients with a surgical plan that included total mastectomy or breast conservation surgery with the removal of the NAC. All patients underwent MRI before surgery on a 1.5-T unit with a 4-channel in vivo dedicated surface breast coil. One radiologist who was blinded to the results of the histologic evaluations of the specimens evaluated the MRI studies. RESULTS: Of the 170 mastectomy specimens evaluated, 37 (21.8%) had neoplastic involvement of the NAC. The MRI findings of enhancement between the index lesion and the NAC and of nipple retraction were considered statistically significant predictors of nipple involvement in breast cancer patients (p < 0.01 and p = 0.01, respectively). The negative predictive value of the combination of these MRI findings was 83.3%. CONCLUSION: Breast MRI is a safe noninvasive method to preoperatively evaluate breast cancer patients eligible for NSM with a high specificity and a high negative predictive value when enhancement between the index lesion and the nipple and nipple retraction are analyzed.

Primary osteosarcoma of the breast: pathological and imaging findings / Osteossarcoma primário da mama: achados patológicos e de imagem

SUMMARY Primary osteosarcoma of the breast (POB) is an extremely rare and aggressive tumor. Differential diagnosis of POB includes osteosarcoma of the chest wall and metaplastic breast carcinoma. Imaging tests that exclude the existence of a direct connection between the tumor and chest wall, as well as histopathological and immunohistochemical studies that rule out the presence of an epithelial component are required for the diagnosis of POB. We report a case of a 69-year old woman with POB. Imaging and pathological findings are presented. Therapeutic approach is discussed in the light of current knowledge, including potential complications.

RESUMO O osteossarcoma primário da mama (OPM) é um tumor extremamente raro e agressivo. O diagnóstico diferencial do OPM inclui o osteossarcoma da parede torácica e o carcinoma metaplásico da mama. Exames de imagem que excluam a existência de uma conexão direta entre o tumor e a parede torácica, e estudos histopatológico e imuno-histoquímico que descartem a presença de um componente epitelial são necessários para o diagnóstico de OPM. Relatamos um caso de OPM em uma mulher de 69 anos de idade. Os achados de imagem e patológicos são apresentados. A abordagem terapêutica é discutida à luz do conhecimento atual, incluindo potenciais complicações.

Primary osteosarcoma of the breast: pathological and imaging findings.

Primary osteosarcoma of the breast (POB) is an extremely rare and aggressive tumor. Differential diagnosis of POB includes osteosarcoma of the chest wall and metaplastic breast carcinoma. Imaging tests that exclude the existence of a direct connection between the tumor and chest wall, as well as histopathological and immunohistochemical studies that rule out the presence of an epithelial component are required for the diagnosis of POB. We report a case of a 69-year old woman with POB. Imaging and pathological findings are presented. Therapeutic approach is discussed in the light of current knowledge, including potential complications.