Proposições acerca das práticas corporais de aventura como conteúdo da Educação Física escolar / Propositions about adventure body practices as content of school Physical Education / Proposiciones sobre las prácticas corporales de aventura como contenidos de la Educación Física escolar

Esse estudo teve como objetivo analisar as proposições acerca da implementação das práticas corporais de aventura (PCAs) como conteúdo da Educação Física escolar. Trata-se de um estudo de revisão sistemática que utilizou como critérios de inclusão artigos originais, publicados no período de 2017 a 2023, nas bases de dados do Portal de Periódicos CAPES. Os estudos analisados mostraram que um número ínfimo de cursos de Educação Física ofertados pelas instituições de cursos superiores no país não possui em suas matrizes curriculares disciplinas relacionadas com as PCAs. Ainda que haja o interesse por uma parcela de professores em trabalhar com as PCAs, os resultados indicaram a falta de incentivos por parte da direção das escolas onde atuam. Soma-se a isso, a ausência de espaços adequados, materiais e equipamentos necessários para a prática das PCAs, que concorrem no sentido de dificultar a implementação desse conteúdo nas aulas de Educação Física.

This study aimed to analyze the propositions regarding the implementation of adventure body practices (ABPs) as content of school Physical Education. This is a systematic review study that used original articles as inclusion criteria, published between 2017 and 2023, in the CAPES Periodicals Portal databases. The studies analyzed showed that a tiny number of Physical Education courses offered by higher education institutions in the country do not have subjects related to ABPs in their curriculum. Even though there is interest among some teachers in working with ABPs, the results indicated a lack of incentives on the part of the management of the schools where they work. Added to this is the lack of adequate spaces, materials and equipment necessary for the practice of ABPs, which contribute to making it difficult to implement this content in Physical Education classes.

Este estudio tuvo como objetivo analizar las propuestas relativas a la implementación de prácticas corporales de aventura (PCAs) como contenidos de la Educación Física escolar. Se trata de un estudio de revisión sistemática que utilizó como criterios de inclusión artículos originales, publicados entre 2017 y 2023, en las bases de datos del Portal de Revistas Periódicas de la CAPES. Los estudios analizados mostraron que un número ínfimo de carreras de Educación Física ofrecidas por instituciones de educación superior en el país no cuentan con materias relacionadas con los PCAs en su currículo. Si bien existe interés entre algunos docentes en trabajar con PCAs, los resultados indicaron una falta de incentivos por parte de la dirección de las escuelas donde trabajan. A esto se suma la falta de espacios adecuados, materiales y equipos necesarios para la práctica de las PCAs, que contribuyen a dificultar la implementación de este contenido en las clases de Educación Física.

Mesenchymal stromal cell therapy during ex vivo lung perfusion ameliorates ischemia-reperfusion injury in lung transplantation.

BACKGROUND: The application of mesenchymal stromal cell (MSC)-based therapy during ex vivo lung perfusion (EVLP) could repair injured donor lungs before transplantation. The aim of this study was to determine the efficacy of MSC therapy performed during EVLP on ischemia-reperfusion injury using a pig lung transplant model. METHODS: Following 24 hours of cold storage, pig lungs were randomly assigned to 2 groups (n = 6 each), the control group without MSC vs the MSC group, where 5 × 106 cells/kg MSCs were delivered through the pulmonary artery during EVLP. After 12 hours of EVLP, followed by a 1-hour second cold preservation period, the left lung was transplanted and reperfused for 4 hours. RESULTS: EVLP perfusate hepatocyte growth factor (HGF) level at 12 hours was significantly elevated in the MSC group compared with the control and was associated with a significant decrease in cell death markers, cleaved caspase-3 and terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells, in the MSC group. The MSC group showed significantly lower interleukin (IL)-18 and interferon gamma levels and a significantly higher IL-4 level in lung tissue at 12 hours of EVLP than the control group. After transplantation, the MSC group showed a significant increase in lung tissue HGF level compared with the control group, associated with a significantly reduced lung tissue wet-to-dry weight ratio. Lung tissue tumor necrosis factor-α level and pathological acute lung injury score were significantly lower in the MSC group than the control group. CONCLUSIONS: The administration of MSCs ameliorated ischemic injury in donor lungs during EVLP and attenuated the subsequent ischemia-reperfusion injury after transplantation.

Current Generation Balloon-Expandable Transcatheter Valve Positioning Strategies During Aortic Valve-in-Valve Procedures and Clinical Outcomes.

OBJECTIVES: This study sought to evaluate SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) positioning using different strategies. BACKGROUND: Aortic valve-in-valve (ViV) is associated with high risk of elevated gradients. METHODS: S3 aortic ViV procedures in stented bioprostheses were studied. Transcatheter heart valve (THV) positioning was analyzed in a centralized core lab blinded to clinical outcomes. A combined endpoint of severely elevated mean gradient (≥30 mm Hg) or pacemaker need was established. Two positioning strategies were compared: central marker method and top of S3 method. Optimal final depth was defined as S3 depth ≤20%. RESULTS: A total of 113 patients met inclusion criteria and were analyzed (76.5 ± 9.7 years of age, 65.8% male, STS score 8 ± 7.6%). THVs had incomplete shortening in comparison to fully expanded valves (92 ± 3.4%), and expansion was more complete in optimal positioning cases compared with others (93.2 ± 2.7% vs. 91.5 ± 3.5%; p = 0.027). The central marker method demonstrated greater correlation with final implantation depth than the top of S3 method (R2 of 0.48 and 0.14; p < 0.001 and p = 0.001, respectively). The combined endpoint rate was 4.3% in the optimal (higher than 3 mm) implantation group, 12% in the intermediate group, and 50% in the low group (p < 0.001). There were no cases of THV embolization. In cases with central marker higher than 3 mm, 72.4% had optimal final depth. In those with central marker higher than 6 mm, 90% had optimal final depth. CONCLUSIONS: Optimal S3 positioning in aortic ViV is associated with better outcomes. Central marker positioning is more reliable than top of S3 positioning. Central marker bottom position should be 3 mm to 6 mm above the ring.

Current generation balloon-expandable transcatheter valve positioning strategies during aortic valve-in-valve procedures and clinical outcomes

OBJECTIVES: This study sought to evaluate SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) positioning using different strategies. BACKGROUND: Aortic valve-in-valve (ViV) is associated with high risk of elevated gradients. METHODS: S3 aortic ViV procedures in stented bioprostheses were studied. Transcatheter heart valve (THV) positioning was analyzed in a centralized core lab blinded to clinical outcomes. A combined endpoint of severely elevated mean gradient ($30 mm Hg) or pacemaker need was established. Two positioning strategies were compared: central marker method and top of S3 method. Optimal final depth was defined as S3 depth #20%. RESULTS: A total of 113 patients met inclusion criteria and were analyzed (76.5 _ 9.7 years of age, 65.8% male, STS score 8 _ 7.6%). THVs had incomplete shortening in comparison to fully expanded valves (92 _ 3.4%), and expansion was more complete in optimal positioning cases compared with others (93.2 _ 2.7% vs. 91.5 _ 3.5%; p » 0.027). The central marker method demonstrated greater correlation with final implantation depth than the top of S3 method (R2 of 0.48 and 0.14; p < 0.001 and p » 0.001, respectively). The combined endpoint rate was 4.3% in the optimal (higher than 3 mm) implantation group, 12% in the intermediate group, and 50% in the low group (p < 0.001). There were no cases of THV embolization. In cases with central marker higher than 3 mm, 72.4% had optimal final depth. In those with central marker higher than 6 mm, 90% had optimal final depth. CONCLUSIONS: Optimal S3 positioning in aortic ViV is associated with better outcomes. Central marker positioning is more reliable than top of S3 positioning. Central marker bottom position should be 3 mm to 6 mm above the ring. (AU)

Prognostic ability of quick-SOFA across different age groups of patients with suspected infection outside the intensive care unit: A cohort study.

OBJECTIVES: Sepsis identification in older patients is challenging. We evaluated the performance of qSOFA across different age groups of patients with suspected infection outside the intensive care unit (ICU). METHODS: Retrospective cohort in a tertiary hospital in Brazil, from January 2016 to December 2016. Outcomes were hospital mortality, ICU admission and bacteremia. Performance of qSOFA was compared over three age groups: (1) reference: ≤65 years, (2) old: 65 to 79 years and (3) very old: ≥80 years. RESULTS: There were 420 patients in the study, of which 259 (61.7%) were ≤65 years, 80 (19%) were 65 to 79 years and 81 (19.3%) were ≥80 years. Old and very old patients had higher qSOFA scores and lower SIRS scores. Overall, qSOFA ≥2 was associated to hospital mortality [OR (95% CI) = 5.8 (3.3-10.4), p < 0.001], ICU admission [OR (95% CI) = 2.7 (1.6-4.6), p < 0.001] and bacteremia [OR (95% CI) = 3.1 (1.7-5.8), p < 0.001]. Those associations were stronger in old and very old patients. qSOFA and SIRS demonstrated overall AUROCs for hospital mortality of 0.72 and 0.50, respectively. CONCLUSION: qSOFA demonstrated good overall accuracy and was more strongly associated to outcomes in old and very old patients, when compared to younger patients.

Perforation of the cecum resulting from a closed-loop obstruction in a patient with an adenocarcinoma of the sigmoid colon: a case report.

INTRODUCTION: Bowel obstruction is one of the principal non-traumatic causes of general surgery emergencies, both in Brazil and worldwide. This condition can be classified according to the degree (complete or incomplete), clinical course (acute or chronic) or nature (mechanical, vascular or functional) of the obstruction. CASE REPORT: ESS, a 62-year old Brazilian woman from Rio de Janeiro, was admitted to the emergency department complaining of constipation of two weeks' duration. She also reported fever and fecal vomiting in the preceding two days.A syndromic diagnosis of bowel obstruction was made, and the patient was referred for CT. The sigmoid colon, descending colon, transverse colon, ascending colon, the cecum and the terminal ileum were resected. DISCUSSION: Colorectal cancer is one of the most common forms of cancer in the elderly, perforation of the cecum occurs in only around 3-8% of cases. 15 This can be explained by the fact that patients with colorectal cancer present with wasting syndrome before the bowel lumen becomes completely obstructed. In a literature review conducted for this study, only one publication was found in which rupture of the cecum was associated with colorectal cancer. CONCLUSION: Although rupture of the cecum associated with colorectal cancer is a rare pathology, it constitutes a surgical emergency; therefore, all surgeons should be aware of the possibility.

Lung Lavage and Surfactant Replacement During Ex Vivo Lung Perfusion for Treatment of Gastric Acid Aspiration-Induced Donor Lung Injury.

BACKGROUND: Ex vivo lung perfusion (EVLP) provides opportunities to treat injured donor lungs before transplantation. We investigated whether lung lavage, to eliminate inflammatory inhibitory components, followed by exogenous surfactant replacement, could aid lung recovery and improve post-transplant lung function after gastric aspiration injury. METHODS: Gastric acid aspiration was induced in donor pigs, which were ventilated for 6 hours to develop lung injury. After retrieval and 10 hours of cold preservation, EVLP was performed for 6 hours. The lungs were randomly divided into 4 groups (n = 5, each): (1) no treatment (control), (2) lung lavage, (3) surfactant administration, and (4) lung lavage, followed by surfactant administration. After another 2-hour period of cold preservation, the left lung was transplanted and reperfused for 4 hours. RESULTS: Physiologic lung function significantly improved after surfactant administration during EVLP. The EVLP perfusate from the lavage + surfactant group showed significantly lower levels of interleukin (IL)-1ß, IL-6, IL-8, and secretory phospholipase A2. Total phosphatidylcholine was increased, and minimum surface tension was recovered to normal levels (≤5 mN/m) in the bronchioalveolar fluid after surfactant administration. Lysophosphatidylcholine in bronchioalveolar fluid was significantly lower in the lavage + surfactant group than in the surfactant group. Post-transplant lung function was significantly better in the lavage + surfactant group compared with all other groups. CONCLUSIONS: Lung lavage, followed by surfactant replacement during EVLP, reduced inflammatory mediators and prevented hydrolysis of phosphatidylcholine, which contributed to the superior post-transplant function in donor lungs with aspiration injury.

Foramen venosum: prevalence, patency and correlation with cephalic index / Foramen venoso: prevalencia, permeabilidad y correlación con el índice cefálico

The foramen venosum (FV) is an anatomical structure situated at the base of the skull, generally posteromedial to the foramen rotundum and anteromedial to the foramen ovale. Its prevalence and patency may be related to the shape of the skull. The objective of this study was to verify the prevalence and patency of the FV and its association with the different skull types. Overall, 143 dry skulls were screened. Of these, 84 were considered to be in an adequate state of conservation and were included in the analysis, which was conducted through a cross-sectional view of the skullcap. The transverse (T) and anteroposterior (AP) diameters of the skull were evaluated by pachymetry and the skull type was classified according to the cephalic index (CI) (CI = T/AP x 100). The presence and patency of the FV were evaluated. Overall, 25 % of the skulls were dolichocephalic, 21.4 % sub-dolichocephalic, 26.2 % mesaticephalic, 16.7 % sub-brachycephalic and 10.7 % brachycephalic. Overall, the FV was found in 41.6 % of the skulls (n=35), with this prevalence being greater in the mesaticephalic skulls (50 %; n=11). Patency was 25 % (n=21). A positive correlation was found between the CI and the presence of the FV in dolichocephalic skulls (on the right-hand side only) and in sub-brachycephalic skulls (bilaterally). In conclusion, the prevalence of the FV was considerable in the sample analyzed and was directly associated with the CI in dolichocephalic and sub-brachycephalic skulls.

El foramen venoso (FV) es una estructura anatómica situada en la base del cráneo, en general, posteromedial al foramen redondo y anteromedial al foramen oval. Su prevalencia y permeabilidad pueden estar relacionados con la forma del cráneo. El objetivo de este estudio fue verificar la prevalencia y permeabilidad del FV y su asociación con los diferentes tipos de cráneo. Se estudiaron 143 cráneos secos. De éstos, 84 fueron considerados en estado adecuado de conservación y se incluyeron en el análisis, realizado mediante la visualización de una sección transversal del cráneo. Los diámetros transversal (T) y anteroposterior (AP) del cráneo se evaluaron mediante paquimetría y el tipo de cráneo se clasificó de acuerdo con el índice cefálico (IC) (IC = T/AP x 100). Se evaluó también la presencia y permeabilidad del FV. El análisis mostró que 25 % de los cráneos eran dolicocefálicos, 21,4 % subdolicocéfalicos, 26,2 % mesaticéfalos, 16,7 % sub-braquicéfalos y 10,7 % de braquicéfalos. El FV se encontró en 41,6 % de los cráneos (n=35), con prevalencia mayor en los cráneos mesaticéfalos (50 %, n=11). La permeabilidad fue del 25 % (n=21). Se encontró una correlación positiva entre el IC y la presencia del FV en cráneos dolicocéfalicos (sólo en el lado derecho) y en sub-braquicéfalos (bilateral). En conclusión, la prevalencia del FV fue considerable en la muestra analizada y se asocia directamente con el IC en cráneos dolicocéfalicos y sub-braquicéfalos.

Mesenchymal stem cell treatment is associated with decreased perfusate concentration of interleukin-8 during ex vivo perfusion of donor lungs after 18-hour preservation.

BACKGROUND: Ex vivo lung perfusion (EVLP) presents a unique therapeutic opportunity to administer mesenchymal stromal cells (MSCs) to lung grafts before transplantation. We sought to determine the optimal route and dose of viable human umbilical cord-derived MSCs to be delivered into ex vivo-perfused damaged swine lungs, and to measure their effect on concentration of growth factors and inflammatory mediators. METHODS: Pig lungs were conventionally retrieved, cold preserved for 18 hours, and perfused normothermically ex vivo for 12 hours. Physiologic data were recorded. No cells were administered to a control group of animals (n = 5). To examine the routes of administration, lungs were administered 50 × 106 MSCs endobronchially (n = 3) or via the pulmonary artery (n = 3). To determine the doses, a dose-escalation study was performed wherein lungs were administered 50 × 106 (n = 3), 150 × 106 (n = 5) and 300 × 106 (n = 3) MSCs via the pulmonary artery. Concentrations of human growth factors and pig cytokines were measured in lung biopsies and perfusate. RESULTS: Intravascular administration of 50 × 106 MSCs was associated with significant and sustained retention of MSCs in lung parenchyma, whereas intrabronchial administration was not. Intravascular administration of 150 × 106 MSCs was the optimal tolerated dose and was associated with increased concentrations of human vascular endothelial growth factor (VEGF) in lung biopsies and decreased concentrations of pig interleukin-8 (IL-8) in the perfusate during 12 hours of EVLP. CONCLUSIONS: Intravascular delivery of 150 × 106 MSCs showed preferred outcome compared with intrabronchial delivery to damaged lungs perfused ex vivo. The method was well tolerated and associated with an increased concentration of human VEGF in the lung tissue and a decreased concentration of pig IL-8 in the perfusate.

Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models.

OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

A note on the diet and foraging behavior of Artibeus lituratus (Chiroptera, Phyllostomidae) in an urban park in southeastern Brazil / Nota sobre dieta e comportamento de forrageio de Artibeus lituratus (Chiroptera, Phyllostomidae) em um parque urbano no sudeste do Brasil

Bats of the genus Artibeus are among the most important seed dispersers in early successional forests. We report observations on the foraging behavior of Artibeus lituratus in Pedra da Cebola Municipal Park, an urban park in the city of Vitória, Espírito Santo, southeastern Brazil. Observations were made during six consecutive days (April 1st to April 6th, 2006). Three mist-nets were opened each night close to a Maclura tinctoria tree (Moraceae), remaining open from 18:00 to 22:00, totaling four hours per night, and 24 hours of sampling effort. We observed two peaks of feeding activity at the tree, one between 18:20 and 19:30, and a second one at 21:00. This is the first observation of Artibeus lituratus feeding on M. tinctoria fruits, therefore adding a new item to the known diet of the species. M. tinctoria fruits have large seeds that are not swallowed by bats, they consume the fruit pulp and discard the seeds. A diet of fruits with large seeds may indicate an important resource not detected in dietary studies based on fecal samples, but better detected by direct observation or by studying feeding roosts. It is important to use different sampling techniques in dietary studies since they complement each other and, together, provide a better knowledge on the diet of bats.

Morcegos do gênero Artibeus estão entre os mais importantes dispersores de sementes em florestas em estágios iniciais de sucessão. Aqui descrevemos observações sobre o comportamento de forrageio de Artibeus lituratus no Parque Municipal da Pedra da Cebola, um parque urbano na cidade de Vitória, Espírito Santo, sudeste do Brasil. As observações foram feitas durante seis dias consecutivos (01 a 06 de Abril de 2006). Três redes de neblina foram abertas cada noite, próximas a uma árvore de Maclura tinctoria, Moraceae, permanecendo abertas das 18:00 às 22:00 horas, totalizando quatro horas por noite, e 24 horas de esforço amostral. Foram observados dois picos de atividade de forrageio, o primeiro entre 18:20 e 19:30 horas, e o segundo às 21:00 horas. Este é o primeiro registro de consumo de frutos de M. tinctoria por A. lituratus, adicionando mais um ítem para a dieta conhecida desta espécie. Os frutos de M. tinctoria possuem sementes de tamanho relativamente grande, que não são ingeridas pelos morcegos. Eles consomem a polpa dos frutos e descartam as sementes. Uma dieta de frutos com sementes grandes pode indicar um recurso importante que não é detectado em estudos de dieta baseados apenas na análise de fezes, e que será detectado apenas por observação direta ou através do estudo de sítios de alimentação. O uso de técnicas de amostragem variadas em estudos de dieta é de extrema importância, pois elas complementam umas às outras, e em conjunto nos fornecem informações melhores e mais precisas sobre a dieta de morcegos do que qualquer uma delas forneceria isoladamente.

Lesiones mamarias no palpables / Breast injuries non palpable

El objetivo de este estudio es presentar los resultados de la casuística de nuestra institución referente a las lesiones mamarias no palpables en el período 1980-1989; se evaluaron 95 casos, distribuidos así: 68 de ellos con nódulos mamográficos (71,58 por ciento) y 27 (28,42 por ciento) contenían microcalcificaciones. En todos los casos realizamos localización de las lesiones con agujas y señalización con azul de metileno, realizando Mastectomía parcial dirigida, efectuando corte congelado en los pacientes con nódulos y esperando el informe histológico definitivo para las microcalsificaciones. Encontramos 10 carcinomas ductales (10.52 por ciento), 5 (5.26 por ciento) en microcalcificaciones, uno de ellos (1.05 por ciento) intraductal y 5 (5.26 por ciento) en nódulos, todos infiltrantes. El tratamiento efectuado consistió en cirugía preservadora en 9 casos (9.47 por ciento) y mastectomía radical modificada en un caso (1.05 por ciento) La axila no evidencia enfermedad ganglionar en 9 casos, resultando estadios tempranos de la enfermedad (9.47 por ciento). Proponemos el estudio mamográfico de pesquisa en pacientes asintomáticos por encima de 35 años de edad, y el adecuado estudio y manejo de las lesiones no palpables de la mama

Enfermedad de Paget de la mama en el Hospital Oncológico "Padre Machado" / Paget disease of the breast in the HOPM

La enfermedad de Paget de la mama es una entidad infrecuente, de allí lo escaso de la literatura nacional e internacional. Revisamos las historias clínicas de nuestro Hospital en el lapso comprendido entre 1961 y 1990, ambos inclusive, encontrando 20 pacientes con esta patología; un caso no se incluye en el estudio ya que ingresó con enfermedad localmente avanzada y falleció sin recibir tratamiento, por lo que evaluamos 19 casos, lo que representa una incidencia de 0,88 por ciento. La edad promedio fue de 57,10 años.El tiempo de evolución de las lesiones osciló entre 1 y 72 meses, correspondiendo 8 pacientes (42,10 por ciento) al rango comprendido entre 7 y 12 meses. La localización más frecuente correspondió a la mama derecha, 13 casos, 68,42 por ciento; se presento como lesión clínicamente limitada el pezón en 10 casos (52,63 por ciento) y en nueve casos se acompañaba de tumor palpable (47,37 por ciento). El tratamiento efectuado consistió en mastectotomía radical modificada en 16 casos (84,21 por ciento), y en una paciente realizamos cirugía preservadora. El número de ganglios linfáticos reportado en el especímen quirúrgico promedio 16,28; cinco pacientes presentaron metástasis axilares (26,31 por ciento). El seguimiento denuestras pacientes osciló entre 2 y 192 meses. Actualmente tenemos 7 casos en control y sin evidencia de enfermedad; cuatro casos desaparecidos de control y ocho fallecidos, de los cuales, cinco a consecuencia de su enfermedad y tres por otras causas

Tratamineto preservador del cáncer mamario: primera comunicación / Preveevator treatmen of breast cancer: first comunication

Se revisan los historiales clínicos de las primeras cien pacientes sometidas a tratamiento preservador por cáncer de mama, en el Servicio de Patología Mamaria del Hospital Oncológico "Padre Machado", entre los años 1980-1986. El procedimiento consiste en realizar una mastectomía parcial oncológica más vaciamiento axilar, acompañado de radioterapia postoperatoria y Quimioterapia adyuvante en caso seleccionados. Por encima de la cuarta década se encontraban el 54// de las pacientes; 94 pacientes consultaron por tumor localizado en la mama izquierda en 55//, a nivel del cuadrante supero externo 52//. La mayoría de las pacientes correspondían a estadios I y II (89//). Se encontraron 4 carcinomas in situ; el 94// de las pacientes tenían adenocarcinoma ductal, que en el 75// eran medianamente diferenciado. Támaño tumoral osciló de 1 a 3 cms. 74//. En el vaciamiento axilar se obtuvo un promedio de 13 ganglios linfáticos. Cumplieron radioterapia postoperatoria 92 pacientes, recibiendo tratamiento a la mama y áreas de drenaje linfático, 85 pacientes. Dosis adicional de refuerzo en 74 casos. Dosis habitual; 5000 y 6000 rads. Se empleo quimioterapia adyuvante en 30 pacientes, siendo el esquema C.M.F. el más utilizado. La sobrevida global obtenida por el método actuarial es 92// a los cinco años. El número de recurrencias es 11, siendo rescatadas 9 pacientes con cirugía radical