Clinical and mammographic profile of patients with breast cancer surgically treated.

OBJECTIVE: to analyze the epidemiological, clinical and mammographic profile of women with breast cancer who were treated at the mastology clinic of the University Hospital of Santa Maria and who underwent breast surgery between January 2007 and December 2012. METHODS: this was a cross-sectional study, approved by the Ethics in Research Committee. A review of the patients' medical records was performed. The data were then exported to a software program for statistical analysis, namely Minitab 14.1. RESULTS: the patients' profile indicated that they were mostly born and raised in Santa Maria (respectively 11.1%, n=16, and 26.3%, n=68). They were about 55.6 years old (SD ± 12.3), white (90.2%, n=213), had already given birth and breastfed their children, were nonsmokers, but also overweight (average BMI of 27 kg/m2). On physical examination of the first medical consultation, these patients, as described in the records: had a palpable mass (81.1%, n=184) measuring over three centimeters, located in the left breast, precisely in the upper outer quadrant (41.4%, n=81). Mammography (39%, n=109) showed that this lump was classified as BIRADS ® 5 (40%, n=81). On histopathological examination, the lump was diagnosed as an invasive ductal cancer (71.1%, n=191). Surgery was generally a radical mastectomy (84.7%, n=236) with axillary dissection (92.5%, n=222). CONCLUSION: some of the epidemiological, clinical and mammographic features mentioned above resembled those found in the literature reviewed. However, these patients had advanced disease and underwent non conservative surgical procedures.

Clinical and mammographic profile of patients with breast cancer surgically treated / Perfil clínico e mamográfico das pacientes com câncer de mama, tratadas cirurgicamente.

Summary Objective: to analyze the epidemiological, clinical and mammographic profile of women with breast cancer who were treated at the mastology clinic of the University Hospital of Santa Maria and who underwent breast surgery between January 2007 and December 2012. Methods: this was a cross-sectional study, approved by the Ethics in Research Committee. A review of the patients' medical records was performed. The data were then exported to a software program for statistical analysis, namely Minitab 14.1. Results: the patients' profile indicated that they were mostly born and raised in Santa Maria (respectively 11.1%, n=16, and 26.3%, n=68). They were about 55.6 years old (SD±12.3), white (90.2%, n=213), had already given birth and breastfed their children, were nonsmokers, but also overweight (average BMI of 27kg/m2). On physical examination of the first medical consultation, these patients, as described in the records: had a palpable mass (81.1%, n=184) measuring over three centimeters, located in the left breast, precisely in the upper outer quadrant (41.4%, n=81). Mammography (39%, n=109) showed that this lump was classified as BIRADS ® 5 (40%, n=81). On histopathological examination, the lump was diagnosed as an invasive ductal cancer (71.1%, n=191). Surgery was generally a radical mastectomy (84.7%, n=236) with axillary dissection (92.5%, n=222). Conclusion: some of the epidemiological, clinical and mammographic features mentioned above resembled those found in the literature reviewed. However, these patients had advanced disease and underwent non conservative surgical procedures. .

Resumo Objetivo: analisar o perfil epidemiológico, clínico e mamográfico de mulheres com câncer de mama atendidas no ambulatório de mastologia do Hospital Universitário de Santa Maria (UFSM) e submetidas à cirurgia de mama no período de janeiro de 2007 a dezembro de 2012. Métodos: estudo de prevalência realizado de modo transversal, após ter sido aprovado pelo Comitê de Ética em Pesquisa. Foram realizadas revisões dos prontuários das pacientes. As informações obtidas foram transpassadas para um programa de análise estatístico, o Minitab 14.1. Resultados: o perfil das pacientes, encontrado no estudo, mostrou que elas eram, na maioria, naturais ou procedentes de Santa Maria (respectivamente 11,1%, n=16, e 26,3%, n=68). Elas tinham 55,6 anos (DP±12,3), eram brancas (90,2%, n=213), gestaram, amamentaram, não eram tabagistas, mas estavam com sobrepeso (IMC médio de 27 kg/m2). No exame físico do primeiro atendimento, essas pacientes, conforme descrito no prontuário, tinham nódulo palpável (81,1%, n=184) com mais de 3 cm na mama esquerda, precisamente no quadrante lateral superior (41,4%, n=81). Na mamografia (39%, n=109), esse nódulo foi classificado como BI-RADS® 5 (40%, n=81). No exame histopatológico, o nódulo foi diagnosticado como câncer do tipo ductal invasor (71,1%, n=191). A cirurgia foi, em geral, uma mastectomia radical (84,7%, n=236) com esvaziamento axilar (92,5%, n=222). Conclusão: concluiu-se que algumas das características epidemiológicas, clínicas e mamográficas citadas acima assemelharam-se com a literatura revisada. No entanto, essas pacientes apresentavam câncer de mama em estádio avançado e foram submetidas a uma técnica cirúrgica não conservadora. .

Sarcopenia: evaluation of different diagnostic criteria and its association with muscle strength and functional capacity / Sarcopenia: avaliação de diferentes critérios diagnósticos e sua associação com a força muscular e capacidade funcional

INTRODUCTION: Sarcopenia has been associated with increased morbidity and mortality in older people. However, there is still no consensus about the best diagnostic criteria for it. OBJECTIVE: This study aimed to evaluate different diagnostic criteria of sarcopenia and their relationship with muscle strength and functional capacity. METHODS: A cross-sectional study was carried out in Santa Maria-RS, Brazil. Body composition was measured by dual-energy X-ray absorptiometry (DXA). Physical performance was evaluated by the Timed-get-up-and-go test (TGUG). Muscle strength was measured with a handgrip dynamometer. The proposed criteria of sarcopenia were evaluated as follows: A) appendicular lean mass index (aLM/ht2), cutoffs 5.5 kg/m2, 2SD, 10th percentile, and 20th percentile of young reference; B) a linear regression model was used to adjust appendicular lean mass (aLM) for both height and fat mass, cutoff 20th percentile of elderly. RESULTS: In total, 104 women agreed to participate in the research, 39 young (20 to 40 years) and 65 elderly (over 60 years). The prevalence of sarcopenia varied from 0% to 17.2% according to the diagnostic criteria. Regarding muscle strength, the aLM/ht2 cutoff 10th percentile was the criterion with greater area under the ROC curve. However, there were no criteria with an area under the ROC curve greater than 0.5 when TGUG was the outcome. The reclassification showed that the criterion B reclassified 66.7% with normal grip strength as sarcopenic. CONCLUSION: Of these criteria, aLM/ht2 cutoff 10th percentile had stronger correlation with muscle strength.

INTRODUÇÃO: Sarcopenia está associada com aumento da morbidade e mortalidade em pessoas idosas. No entanto, ainda não existe consenso sobre o melhor critério diagnóstico para ela. OBJETIVO: Avaliar os diferentes critérios diagnósticos de sarcopenia e sua relação com a força muscular e capacidade funcional. MÉTODOS: Estudo transversal realizado em Santa Maria-RS, Brasil. A composição corporal foi avaliada através de absorciometria por dupla emissão de raios-x (DXA). A capacidade funcional foi inferida por meio dos testes Timed-get-up-and-go (TGUG) e preensão manual com um dinamômetro. Os critérios de sarcopenia propostos foram: A) índice de massa muscular apendicular (aLM/ht²), pontos de corte de 5,5 kg/m2, dois desvios-padrões (dp), percentil 10 e percentil 20 da amostra jovem de referência; B) modelo de regressão linear utilizando massa muscular apendicular (aLM) ajustado para altura e massa gorda (percentil 20 da amostra de idosos). RESULTADOS: No total, 104 mulheres concordaram em participar da pesquisa, 39 jovens (20 a 40 anos) e 65 idosas (acima de 60 anos). A prevalência de sarcopenia variou de 0% a 17,2%, conforme o critério utilizado. Em relação à força muscular, o percentil 10th do aLM/ht² foi o critério com maior área sob a curva ROC. No entanto, nenhum dos critérios diagnósticos para sarcopenia apresentou área sob a curva ROC maior que 0,5 quando TGUG foi utilizado. CONCLUSÃO: Dos critérios avaliados, aLM/ht2 percentil 10 apresentou melhor correlação com força muscular.

Heminegligência / Hemineglect

A heminegligência, um fenômeno em que uma disfunção leva a uma desatenção da metade do campo visual e da percepção corporal, geralmente decorre de lesões do hemisfério parietal e está associado a um pior prognóstico quando acompanhada de anosognosia. O objetivo deste estudo é apresentar o caso de um paciente do sexo masculino, 73 anos, que desenvolveu heminegligência espacial associada à anosognosia e hemianopsia à esquerda decorrentes de um acidente vascular encefálico isquêmico (AU)

Hemineglect, a phenomenon in which a dysfunction leads to inattention of half the visual fi eld and body perception, usually results from damage to the parietal hemisphere and is associated with a worse prognosis when accompanied by anosognosia. The objective of this study is to present the case of a male patient, 73, who developed spatial hemineglect and anosognosia associated with left hemianopia resulting from an ischemic stroke (AU)

Nefropatia isquêmica / Ischemic nephropathy

A doença renal isquêmica ou nefropatia isquêmica relacionada à doença renovascular pode evoluir de forma rápida e progressiva para a insuficiência renal crônica. É fundamental a identificação e o tratamento precoces desta condição clínica, prevenindo a ocorrência de doença renal em estágio terminal, com consequente necessidade de terapia de substituição renal. Há uma década, o controle da hipertensão renovascular era o objetivo primário no manejo de pacientes com doença renovascular. Atualmente, a meta está dirigida principalmente para a estabilização e a melhora da função renal, além do controle dos níveis pressóricos.

Ischemic renal disease or ischemic nephropathy related to renovascular disease can progress rapidly and gradually to chronic renal failure. Early diagnosis and treatment is crucial for this clinical condition, because they can prevent occurrence of end-stage renal disease, with consequent need for renal replacement therapy. A decade ago, renovascular hypertension control was the primary objective in the management of patients with renovascular disease. Currently, the goal is addressed primarily to the stabilization and improvement of renal function, in addition to blood pressure control.

Aspiração manual intrauterina no tratamento do abortamento incompleto até 12 semanas gestacionais: uma alternativa à curetagem uterina / Manual vacuum aspiration uterine treatment of incomplete abortion to 12 gestational weeks: an alternative to curettage

OBJETIVO: Analisar a eficácia e a ocorrência de complicações, além do tempo de permanência hospitalar e as perdas sanguíneas. MÉTODOS: Trinta pacientes foram selecionadas, alternada e consecutivamente, em um dos grupos (15 no Grupo Curetagem e 15 no Grupo de Aspiração manual intrauterina). As variáveis analisadas foram: eficácia do método, ocorrência de complicações, tempo pré-procedimento, tempo de execução do procedimento, tempo pós-procedimento e tempo total de permanência hospitalar, além de hematócrito e hemoglobina, medidas antes e após o procedimento. As pacientes foram avaliadas clinicamente 10 a 14 dias após o procedimento. Para a análise estatística, foram aplicados testes paramétricos e não-paramétricos e o nível de significância admitido foi de p>0,05. RESULTADOS: Ambos os métodos foram eficazes e não foi registrada nenhuma complicação. As perdas sanguíneas foram semelhantes e o tempo de permanência hospitalar foi significativamente menor no Grupo de Aspiração Manual Intrauterina (p=0,03). CONCLUSÃO: a aspiração manual intrauterina é tão eficaz e segura quanto à curetagem uterina, com a vantagem de necessitar menor tempo de permanência hospitalar, o que aumenta a resolutividade do método, melhorando a qualidade da assistência a essas pacientes.

PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

[Manual vacuum aspiration uterine treatment of incomplete abortion to 12 gestational weeks: an alternative to curettage]. / Aspiração manual intrauterina no tratamento do abortamento incompleto até 12 semanas gestacionais: uma alternativa à curetagem uterina.

PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

Agenesia de veia cava inferior associada à trombose venosa profunda / Agenesis of inferior vena cava associated with deep venous thrombosis

A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior.

The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

Pseudoartrose congênita da clavícula / Congenital pseudartrosis of the clavicle

A pseudoartrose congênita da clavícula é uma doença rara de etiologia desconhecida. Trata-se de uma patologia não familiar, em geral unilateral, com alta predominância pelo lado direito e pelo sexo masculino. Foi descrita inicialmente por Fitzwillians em 1910. Existem até o momento aproximadamente 200 relatos de caso na literatura. O diagnóstico diferencial inclui a pseudoartrose pós-traumática (tocotraumatismo), a disostose cleidocranial, a osteogênese imperfeita e a neurofibromatose. Os autores apresentam um paciente, masculino, de 28 dias de vida, com uma massa indolor situada no terço médio da clavícula direita.

Congenital pseudartrosis of the clavicle is a rare disease of unknown etiology. It is a non-familial disorder which is usually unilateral, with a high prevalence for the right side and males. It was first reported by Fitzwillians in 1910. There are up to now about 200 case reports in the literature. The differential diagnosis includes post-traumatic pseudartrosis (birth trauma), cleidocranial disostosis, imperfect osteogenesis, and neurofibromatosis. The authors report the case of a 28-day old male patient with a painless mass at the medium third of the right clavicle.