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1.
Breast Dis ; 41(1): 1-3, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34219707

RESUMO

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , COVID-19/prevenção & controle , Cateterismo Venoso Central/métodos , Controle de Infecções/métodos , Segurança do Paciente , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais , Quimioterapia Adjuvante , Procedimentos Clínicos , Feminino , Humanos , Controle de Infecções/normas , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela/normas
2.
Rev. enferm. UERJ ; 29: e56924, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224444

RESUMO

Objetivo: descrever a incidência de complicações em feridas operatórias de mastectomia e identificar fatores associados. Método: estudo retrospectivo desenvolvido em uma coorte hospitalar de 545 mulheres mastectomizadas por câncer de mama no ano 2018 em um centro de assistência de alta complexidade em oncologia da cidade do Rio de Janeiro, Brasil, após aprovação por Comitê de Ética em Pesquisa. Os dados foram coletados a partir dos prontuários, permitindo cálculos da taxa de incidência e da razão da taxa de incidência para cada complicação. Resultados: a complicação que apresentou maior taxa de incidência foi o sangramento (57,14/100 mastectomias-dia), tendo como fatores associados a raça/cor da pele não branca (Razão da Taxa de Incidência: 3,11) e a diabetes mellitus (Razão da Taxa de Incidência: 0,48). Conclusão: os fatores associados ao sangramento da ferida operatória apontam para a necessidade de novas práticas no cuidado ao pós-operatório de mulheres mastectomizadas.


Objective: to describe the incidence of complications in mastectomy surgical wounds and to identify associated factors. Method: this retrospective study was conducted in a hospital cohort of 545 women mastectomized for breast cancer in 2018 at a high-complexity cancer care center Rio de Janeiro City, Brazil, after approval by the research ethics committee. Data were collected from medical records, allowing incidence rate and incidence rate ratio to be calculated for each complication. Results: the complication with the highest incidence rate was bleeding (57.14/100 mastectomies-day), associated factors being non-white race/skin color (incidence rate ratio 3.11) and diabetes mellitus (incidence rate ratio 0.48). Conclusion: the factors associated with bleeding from the surgical wound point to the need for new practices in post-operative care for women with mastectomies.


Objetivo: describir la incidencia de complicaciones en heridas quirúrgicas de mastectomía e identificar factores asociados. Método: estudio retrospectivo desarrollado en una cohorte hospitalaria de 545 mujeres mastectomizadas por cáncer de mama en 2018 en un centro de atención de alta complejidad en oncología de la ciudad de Río de Janeiro, Brasil, previa aprobación del Comité de Ética en Investigación. Los datos se obtuvieron de las historias clínicas, lo que permitió calcular la tasa de incidencia y el cociente de la tasa de incidencia para cada complicación. Resultados: la complicación que presentó mayor tasa de incidencia fue el sangrado (57,14 / 100 mastectomías-día), con factores asociados a la raza / color de piel no blanca (índice de tasa de incidencia: 3,11) y diabetes mellitus (índice de tasa de incidencia: 0,48). Conclusión: los factores asociados al sangrado de la herida quirúrgica apuntan a la necesidad de nuevas prácticas en el cuidado al postoperatorio de las mujeres con mastectomía.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Complicações Pós-Operatórias/epidemiologia , Ferida Cirúrgica/complicações , Mastectomia/efeitos adversos , Brasil/epidemiologia , Neoplasias da Mama/cirurgia , Incidência , Estudos Retrospectivos , Fatores de Risco , Hemorragia Pós-Operatória/epidemiologia
3.
BMJ ; 375: e066542, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34759002

RESUMO

OBJECTIVE: To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery. DESIGN: Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation. SETTING: 17 UK National Health Service cancer centres. PARTICIPANTS: 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196). INTERVENTIONS: Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months. MAIN OUTCOME MEASURES: Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective. RESULTS: Between 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale -0.68, -1.23 to -0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) -2.02, -3.11 to -0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average -£387 (€457; $533) (95% confidence interval -£2491 to £1718; 2015 pricing) and was cost effective compared with usual care. CONCLUSIONS: The PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications. TRIAL REGISTRATION: ISRCTN Registry ISRCTN35358984.


Assuntos
Terapia Comportamental/métodos , Neoplasias da Mama/reabilitação , Terapia por Exercício/métodos , Mastectomia/reabilitação , Modalidades de Fisioterapia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/economia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Análise Custo-Benefício , Avaliação da Deficiência , Terapia por Exercício/economia , Feminino , Humanos , Mastectomia/economia , Pessoa de Meia-Idade , Qualidade de Vida , Medicina Estatal , Resultado do Tratamento , Reino Unido
4.
Surg Clin North Am ; 101(6): 1033-1044, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774266

RESUMO

Breast surgical oncology is a rapidly evolving field with significant advances shaped by practice-changing research. Three areas of ongoing controversy are (1) high rates of contralateral prophylactic mastectomy (CPM) in the United States despite uncertain benefit, (2) indications for and use of neoadjuvant chemotherapy (NACT) and endocrine therapy (NET), and (3) staging and treatment of the axilla, particularly after neoadjuvant systemic therapy. We discuss the patient populations for whom CPM may or may not be beneficial, indications for NACT and NET, and the trend toward de-escalation of locoregional axillary treatment.


Assuntos
Neoplasias da Mama/cirurgia , Antineoplásicos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Axila , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Humanos , Excisão de Linfonodo , Mamoplastia , Mastectomia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Mastectomia Profilática
5.
Zhonghua Zhong Liu Za Zhi ; 43(11): 1203-1208, 2021 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-34794225

RESUMO

Objective: To analyze the prognostic factors of breast cancer patients with isolated chest wall recurrence (ICWR) after mastectomy, and investigate the optimal treatment. Methods: A total of 201 breast cancer patients with ICWR after mastectomy who were treated in Cancer Hospital, Chinese Academy of Medical Sciences and the Fifth Medical Center Chinese PLA General Hospital from October 1998 to April 2018 were retrospectively analyzed. The median follow-up was 92.8 months and survival data were obtained. Results: Among 201 patients with ICWR, 103 patients developed subsequent locoregional recurrence (sLRR) and 5-year cumulative sLRR rate was 49.1%; 134 patients developed distant metastasis (DM) and 5-year DM rate was 64.4%; 103 patients died, the median progression-free survival (PFS) was 17.4 months and the 5-year PFS rate was 23.2%; the median overall survival (OS) was 62.5 months and the 5-year OS rate was 52.1%. Multivariate analysis showed that the recurrence interval (HR=2.17, 95% CI: 1.26-3.73) and the locoregional treatment (HR=1.59, 95% CI: 1.05-2.40) were the independent prognostic factors for sLRR. The initial HER2 status (HR=1.60, 95% CI: 1.03-2.48) was the independent prognostic factor for DM. The recurrence interval (HR=1.99, 95% CI: 1.30-3.04), the locoregional treatment (HR=1.99, 95% CI: 1.43-2.76) and the treatment modalities after recurrence (HR=1.70, 95% CI: 1.18-2.46) were the independent prognostic factors for PFS. The initial HER2 status (HR=1.69, 95% CI: 1.02-2.81), the recurrence interval (HR=1.85, 95% CI: 1.15-2.98) and the treatment modalities after recurrence (HR=2.48, 95% CI: 1.56-3.96) were the independent prognostic factors for OS. Conclusions: Breast cancer patients after ICWR have an optimistic OS until now, but the risk of sLRR and DM is high. Comprehensive treatment modalities including surgery, radiotherapy and systemic therapy improve the outcome of breast cancer patients with ICWR after mastectomy.


Assuntos
Neoplasias da Mama , Parede Torácica , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mastectomia , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos
6.
Gan To Kagaku Ryoho ; 48(11): 1393-1395, 2021 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-34795133

RESUMO

The case was a 40-year-old female who was aware of a right breast mass for 1 year before her first visit. She had visited her previous doctor because the mass was gradually increasing in size. After close examination, she was diagnosed with Stage ⅢC triple-negative breast cancer. She underwent 4 courses of EC therapy and 7 courses of paclitaxel(PTX)plus bevacizumab( Bev)therapy and was then, referred to our hospital for resection. We instituted a 2-month break from Bev to prevent postoperative complications. She underwent a right mastectomy, combined chest wall resection, lymph node dissection, and chest wall reconstruction. Because the postoperative course was good and quality of life improved, the multidisciplinary treatment with surgery and pharmacotherapy was considered effective in locally advanced breast cancer.


Assuntos
Neoplasias da Mama , Neoplasias de Mama Triplo Negativas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Paclitaxel/uso terapêutico , Qualidade de Vida , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Neoplasias de Mama Triplo Negativas/cirurgia
7.
Cir Cir ; 89(S1): 109-113, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762628

RESUMO

Thoracoepigastric flap is rarely used for reconstruction of the large chest wall defects due to potential for necrosis and delayed wound healing. This article presents three patients with breast cancer, who underwent mastectomy and chest wall reconstruction with thoracoepigastric flap and subsequently developed distal flap necrosis. The negative pressure wound therapy may eliminate the need for additional graft and/or flap surgery in patients with large necrosis size.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Necrose/etiologia , Estudos Retrospectivos , Retalhos Cirúrgicos
8.
Sensors (Basel) ; 21(21)2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34770371

RESUMO

The aim of the study was to evaluate the temperature parameter of the breast area in patients undergoing radiotherapy at various intervals. The relationship between temperature changes on the patient's skin and the time after the end of radiotherapy was studied. Measurements with a thermal imaging camera were performed in a group of twelve volunteers. Six of them were healthy women who did not have thermal asymmetry between the breasts, whereas six were diagnosed with breast cancer and underwent mastectomy due to the advanced stage of the disease. The patients were qualified for radiation therapy. Thermographic examinations were performed before treatment, two months later and then six months after the end of the treatment. Temperature differences between the healthy breasts and the treated areas were assessed. Additionally, the correlation between a patient's skin temperature changes and the time after the end of radiotherapy was analyzed. The highest skin temperature increase (1.47 °C) was observed 6 months after the end of RT compared to the measurement before treatment. It seems that thermovision may bring a new tool for quantitative analyses of the temperature effects of radiotherapy.


Assuntos
Neoplasias da Mama , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Feminino , Humanos , Mastectomia , Temperatura , Termografia
9.
BMJ Case Rep ; 14(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789529

RESUMO

Subcutaneous mastectomy plays a major role in female to male (FtM) gender affirming surgery, and obtaining a flattering chest contour remains a challenge to the surgeon. We present an operative method using a dermal nipple-areola complex (NAC) flap, with the aim to create a naturally masculine appearance, while reducing the risk of NAC complications by maintaining sufficient neurovascularisation. This case report describes how the novel approach may potentially be applied as an alternative to the traditionally performed free nipple graft technique in FtM gender confirming surgery. The technique is simple, provides an aesthetically appealing outcome and presumably poses a low risk of NAC complications. Intraoperatively, it allows for good exposure and a uniform removal of breast tissue, as well as repositioning and/or resizing of the NAC where required.


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia Subcutânea , Feminino , Humanos , Masculino , Mastectomia , Mamilos/cirurgia
10.
Anticancer Res ; 41(11): 5365-5375, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732406

RESUMO

Reconstructive breast surgery following total or partial mastectomy can be performed using autologous tissues or breast implants, and each has its own set of complications. Most women do not experience significant complications and are highly satisfied but breast reconstruction must consider potential complications from surgical techniques, as well as additional complications that may arise from oncological treatment modalities such as radiation therapy and chemotherapy. The aim of this article is to provide a systemic overview of possible complications that may arise in the course of reconstructive breast surgery. Complications associated with flap-based or implant-based breast reconstruction can be classified as: i) Complications inherent to surgery and common to all, including seroma, bleeding, and hematoma; skin necrosis; and infection, among others. ii) Complications specifically related to reconstruction, such as flap ischemia/necrosis/loss; fat necrosis; implant capsular contracture; implant failure, exposure, or malposition. In conclusion, this overview of possible complications is intended to improve the decision-making process when considering breast reconstruction.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Mamoplastia/efeitos adversos , Mastectomia , Complicações Pós-Operatórias/etiologia , Implante Mamário/instrumentação , Tomada de Decisão Clínica , Feminino , Humanos , Mamoplastia/instrumentação , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Desenho de Prótese , Qualidade de Vida , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
Anticancer Res ; 41(11): 5657-5665, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732439

RESUMO

BACKGROUND/AIM: Reduction of postoperative stress is a modern tenet in surgical oncology with the aim of reducing early postoperative lymphopenia. Our prospective study evaluated post-operative immune response at baseline and postoperative day (POD) 1 and 2 after direct-to-implant pre-pectoral (PP) breast reconstruction with titanium-coated polypropylene mesh versus subpectoral (SP) breast reconstruction. PATIENTS AND METHODS: Between January and December 2020, 37 patients were randomized between PP (n=17) or SP (n=16) reconstruction. Baseline and operative data were analyzed. Postoperative pain assessment using numeric pain rating scale (NPRS), and a full blood count with lymphocyte subsets were collected before surgery, and on POD1 and POD2. Data were evaluated by two-way analysis of variance test. RESULTS: Baseline data did not demonstrate any statistical difference. Inter-group analysis did not provide any statistically significant difference in leukocytes, total lymphocytes, and lymphocytes subsets among SP and PP reconstruction groups (p>0.05). However, compared to specificity, the PP group experienced shorter operative time, with a mean difference 30.19 min, lower blood loss (p=0.017), lower rate of postoperative anemia (p=0.039), and a more favorable profile in inter-group pain analysis (p<0.001). CONCLUSION: PP reconstruction with titanium-coated polypropylene mesh does not increase immunological impairment in the early postoperative period when compared with SP reconstruction and provides lower postoperative pain, reduction of operative time, and lower rate of postoperative anemia.


Assuntos
Implante Mamário/instrumentação , Implantes de Mama , Neoplasias da Mama/cirurgia , Mastectomia , Complicações Pós-Operatórias/imunologia , Idoso , Anemia/etiologia , Anemia/prevenção & controle , Implante Mamário/efeitos adversos , Neoplasias da Mama/patologia , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Polipropilenos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Propriedades de Superfície , Telas Cirúrgicas , Fatores de Tempo , Titânio , Resultado do Tratamento
12.
Anticancer Res ; 41(11): 5723-5728, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732445

RESUMO

BACKGROUND/AIM: Areola-sparing mastectomy (ASM), a conservative mastectomy with nipple hollowing, can be applied to intraductal breast cancer with a tumour-nipple-areola complex (NAC) distance of ≤2 cm. Here, we evaluated the safety and effectiveness of ASM. PATIENTS AND METHODS: We retrospectively reviewed the surgical outcomes of 61 patients (64 breasts) who underwent ASM between 2016 and 2020. RESULTS: Of the 64 breasts, 33 (51.6%) underwent ASM because the tumour-NAC distance on preoperative magnetic resonance imaging was ≤2 cm. Two patients had positive excisional margins but these were at the posterior areola surface therefore additional resection was possible. Over a median postoperative observation period of 16 months (range=3-52 months), one patient developed chest wall recurrence that was resected and did not recur again. CONCLUSION: For breast cancer with an extensive intraductal component, ASM is a good alternative to nipple-sparing mastectomy because it allows safe resection while maintaining aesthetics.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Mastectomia , Mamilos/cirurgia , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Margens de Excisão , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Neoplasia Residual , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
13.
World J Surg Oncol ; 19(1): 328, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34781971

RESUMO

BACKGROUND: Paraneoplastic neurological syndromes constitute rare neurological complications of malignant disease, manifesting in <1% of patients with cancer. Opsoclonus-myoclonus syndrome (OMS) presents with chaotic ocular saccades (opsoclonus), spontaneous muscular jerking (myoclonus) that may be accompanied by ataxia, strabismus, aphasia, or mutism. Its paraneoplastic variant in the adult is most commonly associated with small-cell lung cancer, followed by breast cancer. Importantly, neurological symptoms usually precede the diagnosis of breast cancer and tend to recure after its treatment. CASE PRESENTATION: A 43-year-old premenopausal Caucasian woman with a medical history of hypertension was admitted following an episode of focal seizure. This progressed to generalised tonic-clonic seizures and she was subsequently loaded with phenytoin, valproate, and levetiracetam. Initial workup included whole body CT scan, viral and autoimmune serology. The CT scan revealed an enhancing right axillary lymph node, which in combination with Anti-Ri antibody positivity raised the spectre of paraneoplastic OMS. MRI of the head revealed subtle nonspecific white matter signal change within the centrum semiovale without any mass lesions, while MRI of the spine was unremarkable. An uncomplicated right mastectomy and axillary lymph node clearance was performed: histopathology revealed a 9-mm, grade 2, oestrogen receptor-positive, progesterone receptor-negative (ER8, PR0), Her2-negative invasive ductal carcinoma, and 4/6 positive lymph nodes (T1b N2 M0). Two months later, she was readmitted with vertigo, diplopia, facial weakness, and ataxia, setting the diagnosis anti-Ri syndrome recurrence. MDT recommended mammogram and ultrasound of the left breast, which were normal. Subsequently, four months after initial discharge, she suffered another neurological recurrence; due to concomitant abdominal pain, PET-CT was performed demonstrating a hypermetabolic right ovarian focus. Bilateral salpingo-oophorectomy was performed as per gynaecology MDT and final histology showed normal tubes and ovaries. She has remained on remission since then, with a negative annual mammogram follow-up. CONCLUSIONS: In conclusion, we report a case of OMS associated with breast cancer anti-Ri onconeural antibody. Its manifestations preceded the diagnosis of malignancy and it persisted after cancer treatment, underlining the importance for high clinical suspicion in cases of classical paraneoplastic neurological syndromes as well as the need for long-term clinical follow-up.


Assuntos
Neoplasias da Mama , Síndrome de Opsoclonia-Mioclonia , Adulto , Neoplasias da Mama/complicações , Feminino , Humanos , Mastectomia , Recidiva Local de Neoplasia , Síndrome de Opsoclonia-Mioclonia/etiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico
14.
World J Surg Oncol ; 19(1): 325, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781985

RESUMO

BACKGROUND: Surgical devices are commonly used during breast conservative surgery (BCS) to provide better hemostasis. The Harmonic scalpel has recently gained momentum as an effective tool for intraoperative bleeding reduction. This comparative study was designed to determine the efficacy of Harmonic Focus in reducing postoperative complications of BCS after neoadjuvant chemotherapy (CTH) compared to the conventional method using monopolar diathermy. RESULTS: A prospective, nonrandomized, comparative study was conducted on patients scheduled to undergo BCS with axillary dissection after neoadjuvant CTH. Patients in the Harmonic Focus group had significantly shorter operative times than the monopolar electrocautery group (101.32 ± 27.3 vs. 139.3 ± 31.9 min, respectively; p < 0.001). Besides, blood loss was significantly lower in the Harmonic Focus group (117.14 ± 35.6 vs. 187 ± 49.8 mL, respectively; p < 0.001). Postoperatively, patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (p < 0.001) and shorter time until drain removal (p < 0.001). Likewise, patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter time until drain removal than monopolar electrocautery (p < 0.001). The incidence of postoperative complications was comparable between both groups (p = 0.128). CONCLUSIONS: This study confirmed the superiority of Harmonic Focus compared to monopolar electrocautery among patients receiving neoadjuvant CTH before BCS.


Assuntos
Eletrocoagulação , Terapia Neoadjuvante , Humanos , Mastectomia , Prognóstico , Estudos Prospectivos
15.
Wounds ; 33(10): 260-262, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34735363

RESUMO

Surgical site infection (SSI) incidence is affected by 3 types of interacting factors: the infecting organisms (eg, number, type, virulence), the local wound environment (eg, foreign matter, aseptic technique, wound dressings), and systemic host defenses (eg, smoking, obesity, diabetes). Cancer or related chemotherapy and other aspects of cancer care may affect host defenses, as evidenced by increased SSI risk following "clean" surgery to remove breast cancer tissue compared with similar "clean" surgeries in patients who do not have cancer. If patient risk factors for development of an SSI are strictly controlled in individuals undergoing breast cancer surgery, the likelihood of the development of an SSI drops sharply, creating the illusion that preoperative antibiotics are not needed. This Evidence Corner, which includes 2 studies, clarifies evidence supporting the use of recognized preoperative antibiotic administration to support host defenses in patients undergoing breast cancer surgery. In the first study, the controversy about wound dressings following cancer surgery is also explored. Some surgeons question whether routine use of gauze dressings promotes the ideal local wound environment after surgical excision of cancerous tissue. Disintegrating gauze strands can act as foreign bodies in wounds, and gauze dressings have been reported to increase SSI incidence in clean surgical wounds. The second study compared healing and SSI incidence of Mohs surgical excisions dressed with either an antibiotic-free, film-forming silicone wound dressing or a triple antibiotic primary dressing following Mohs micrographic or non-Mohs dermatologic surgery. The surprising results reinforce the importance of the local wound environment as a key factor in minimizing SSI in oncologic surgery.


Assuntos
Neoplasias , Infecção da Ferida Cirúrgica , Antibacterianos/uso terapêutico , Bandagens , Humanos , Mastectomia , Neoplasias/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Cicatrização
16.
Ann Palliat Med ; 10(9): 10124-10129, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628933

RESUMO

Breast cancer is the most commonly diagnosed malignant tumor and the leading cause of cancer-related death in women worldwide. Previous studies have demonstrated that patients with human epidermal growth factor receptor 2 (HER2)-positive/hormone receptor (HR)-positive metastatic breast cancer can benefit from HER2-targeted therapy. Pyrotinib, an irreversible tyrosine kinase inhibitor (TKI), has been demonstrated to be effective and safe in treating HER2-positive breast cancer patients. Letrozole is an aromatase inhibitor (AI) which has shown better clinical efficacy when combined with HER2 inhibitors in treating patients with HER2-positive and HR-positive breast cancer than has hormonal therapy alone. However, the effect of combination therapy with pyrotinib plus letrozole in HER2-positive/HR-positive metastatic breast cancer patients has not yet been investigated. In this case report, a 57-year-old female patient with HER2-positive/HR-positive breast cancer received modified radical mastectomy and experienced subsequent relapse and metastasis. She was diagnosed with relapsed right breast cancer, a right chest bone mass accompanied by bone destruction, and metastases in the chest wall and both lungs. She was then enrolled in a phase II clinical trial and was treated with pyrotinib plus letrozole, and achieved a durable clinical response. Our case shows that combination therapy with pyrotinib plus letrozole may provide significant clinical benefit for patients with HER2-positive/HR-positive metastatic breast cancer, with tolerable adverse events.


Assuntos
Neoplasias da Mama , Acrilamidas , Aminoquinolinas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Feminino , Hormônios , Humanos , Letrozol/uso terapêutico , Mastectomia , Pessoa de Meia-Idade
17.
BMC Surg ; 21(1): 371, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670543

RESUMO

BACKGROUND: Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. METHODS: This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. RESULTS: A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30-49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5-8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2-14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1-5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3-3.9)). No in-hospital mortality occurred during the course of the study. CONCLUSION: Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.


Assuntos
Neoplasias da Mama , Mastectomia Radical Modificada , Adulto , Neoplasias da Mama/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Mastectomia , Pessoa de Meia-Idade , Seroma
18.
J Opioid Manag ; 17(5): 389-396, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34714539

RESUMO

OBJECTIVE: We evaluated the effect of the addition of 100 ng of naloxone to fentanyl-bupivacaine mixture used in thoracic paravertebral block (PVB) on the duration and the quality of post-mastectomy analgesia. DESIGN: A randomized double-blinded trial. SETTING: Oncology surgery unit. PATIENTS AND PARTICIPANTS: This study included 135 patients, aged 40-60 years of either sex presented for elective unilateral-modified radical mastectomy. INTERVENTIONS: Patients were divided randomly into three groups: group I, received 0.3 mL/kg of 0.25 percent bupivacaine; group II, received 0.3 mL/kg of 0.25 percent bupivacaine, fentanyl 50 µg, and naloxone 100 ng; group III, received 0.3 mL/kg of 0.25 percent bupivacaine and fentanyl 50 µg. MAIN OUTCOME MEASURE(S): The visual analog scale was assessed immediately post-operative, every 2 hours till 12 hours, and then every 6 hours for 24 hours; the time of first and total amount of rescue analgesia and side effects during the first 24 hours were recorded. RESULTS: Group II showed a significant prolonged analgesia with a delayed first request of rescue analgesia and lower amount of morphine (592.1 ± 14.9 minutes and 7.28 ± 7.81 mg, respectively) than groups I (127.7 ± 35.1 minutes and 19.84 ± 2.56 mg, respectively) and III (232.2 ± 9.27 minutes and 13.52 ± 1.74 mg, respectively) as p < 0.001. CONCLUSION: Using naloxone as additives in PVB has been promising and effective in controlling post-mastectomy pain.


Assuntos
Analgesia , Neoplasias da Mama , Analgésicos Opioides , Anestésicos Locais , Neoplasias da Mama/cirurgia , Bupivacaína , Método Duplo-Cego , Feminino , Fentanila , Humanos , Mastectomia , Mastectomia Radical Modificada , Naloxona , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos
19.
J Prev Med Hyg ; 62(2): E382-E385, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34604577

RESUMO

Introduction: In recent times, improved diagnostic techniques have revealed an alarming number of cases of mucormycosis in immunocompetent individuals. The Saksenaea species, is a rare cause of mucormycosis, and is often associated with skin and subcutaneous infection due to trauma in both immunocompromised and immunocompetent subjects. The purpose of this study was therefore, through a review of the literature, to investigate the problem of infections caused by Saksenaea Erythrospora, evaluating the clinical manifestations of the infection, the triggering factors, the therapies and patients' outcomes, implementing and updating what already reported in literature. Methods: A research of peer-reviewed literature in the electronic databases MEDLINE (PubMed) and Scopus was conducted in the period June 2020-January 2021 using the key word "Saksenaea erythrospora". Studies in Italian, English, French, Spanish focused on cases of Saksenaea erythrospora were included, without time restrictions. Studies that provided ambiguous or insufficient data were excluded. Results: Bibliographic research yielded 23 publications; 7 were included in the review. The studies were published between 2011 and 2015 and involved a total of 11 patients of average age 37.9 years (SD 17.23) hospitalized in several hospitals in: USA, India, Argentina, Colombia, Thailand. 6 patients were women, 5 men. All patients had an almost normal immune status. The causes of the infection were: injections, traumas, surgery. Two patients, despite surgical and medical therapy, died. Conclusions: Our review partially updated what already published, because only one new study was found. Serious necrotizing infections from Saksenaea erythrospora have been observed in recent years and a early identification and timely management are essential to reduce morbidity and mortality. A greater awareness and education about the risks deriving from carrying out surgical procedures abroad, especially in precarious hygiene situations, could be additional effective weapons to reduce the incidence of these infections.


Assuntos
Neoplasias da Mama/microbiologia , Doenças Transmissíveis Emergentes/microbiologia , Mucorales , Mucormicose/diagnóstico , Adulto , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Feminino , Humanos , Imunocompetência , Masculino , Mastectomia , Mucormicose/imunologia
20.
Medicine (Baltimore) ; 100(37): e26952, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664826

RESUMO

ABSTRACT: It is necessary to elucidate the potential risk factors of pulmonary infection to provide references for the management of breast cancer.Our study was a retrospective design, patients who underwent modified radical mastectomy for breast cancer in our department of breast surgery from January 2019 to November 2020 were included. The personal and clinical data of included patients with and without pulmonary infection were compared.A total of 234 patients with radical mastectomy were included, the incidence of pulmonary infection was 15.38% with 95%confidence interval (CI) 11.42% to 18.98%. There were significant differences in the age, body mass index, diabetes, duration of surgery, combined radiotherapy and chemotherapy, and duration of drainage between patients with and without pulmonary infections (all P < .05). Logistic regression analysis indicated that age ≥55 years (odds ratio [OR] 2.128, 95%CI 1.105-3.426), body mass index ≥ 24 kg/m2(OR 2.344, 95%CI 1.031-3.299), diabetes (OR 2.835, 95%CI 1.132-4.552), duration of surgery ≥120 minutes (OR 1.394, 95%CI 1.012-1.044), combined radiotherapy and chemotherapy (OR 3.122, 95%CI 1.124-5.273), duration of drainage ≥5 days (OR 1.851, 95%CI 1.112-2.045) might be the independent risk factors of pulmonary infection in patients after radical mastectomy(all P < .05). Pseudomonas aeruginosa and Klebsiella pneumoniae are the most commonly seen bacteria.The incidence of postoperative pulmonary infections in breast cancer patients is high, and there are many associated risk factors. The perioperative management of patients should be strengthened targeted on those risk factors in clinical practice.


Assuntos
Neoplasias da Mama/complicações , Complicações Pós-Operatórias/prevenção & controle , Infecções Respiratórias/prevenção & controle , Adulto , Índice de Massa Corporal , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Mastectomia/efeitos adversos , Mastectomia/métodos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia , Infecções Respiratórias/etiologia , Estudos Retrospectivos , Fatores de Risco
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