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1.
Gan To Kagaku Ryoho ; 47(9): 1387-1389, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130707

RESUMO

A woman in her 30s presented to our hospital with the chief complaint of a right breast mass after the birth of her first child. She was diagnosed as having right invasive ductal carcinoma of Luminal-B type and T3N3cM0, stage Ⅲc. While undergoing neoadjuvant chemotherapy, she received genetic counseling and underwent genetic testing and was determined to have deleterious BRCA1 and BRCA2 mutations. After completing chemotherapy, she underwent a right total mastectomy and axillary lymph node dissection. Two years postoperatively, she requested to undergo a contralateral risk-reducing mastectomy( CRRM)of her left breast. Therefore, CT and breast MRI were performed to confirm the absence of contralateral lesions and distant metastases, and subsequently, CRRM was performed. Postoperative pathology results showed non-invasive ductal carcinoma lesions at 5 sites. In the case of hereditary breast and ovarian cancer syndrome such as in this study, lesions may be discovered at an early stage by performing risk-reducing mastectomy.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Carcinoma Ductal , Carcinoma Intraductal não Infiltrante , Síndrome Hereditária de Câncer de Mama e Ovário , Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Criança , Feminino , Síndrome Hereditária de Câncer de Mama e Ovário/genética , Síndrome Hereditária de Câncer de Mama e Ovário/cirurgia , Humanos , Mastectomia
2.
Gan To Kagaku Ryoho ; 47(10): 1505-1507, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130751

RESUMO

Case 1: A 68-year-old woman was diagnosed with advanced HER2-positive breast cancer(T2N2aM0, cStage ⅢA). She was treated with 4 courses of preoperative chemotherapy with pertuzumab, trastuzumab, and docetaxel. She was diagnosed to have achieved partial remission(PR), and subsequently underwent a mastectomy and axillary dissection. Pathological examination revealed smaller than 1 mm(Grade 2b). Case 2: A 59-year-old woman was diagnosed with advanced HER2-positive breast cancer(T4bN1M0, cStage ⅢB). She was treated with 4 courses of preoperative chemotherapy with pertuzumab, trastuzumab, and docetaxel. She was diagnosed to have achieved PR(primary lesion: complete remission), and subsequently underwent a mastectomy and axillary dissection. Pathological examination revealed complete pathological response(Grade 3). Combination therapy with pertuzumab, trastuzumab, and docetaxel appears to be a useful preoperative chemotherapy regimen for locally advanced HER2-positive breast cancer.


Assuntos
Neoplasias da Mama , Idoso , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Docetaxel , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptor ErbB-2 , Trastuzumab/uso terapêutico
6.
Praxis (Bern 1994) ; 109(14): 1127-1133, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33109001

RESUMO

Cosmetic Breast Augmentation without Silicone Implants Abstract. Cosmetic breast augmentation procedures without silicone implants are becoming increasingly popular. Mastopexy can be adapted to the needs of the patient and usually result in an at least optical augmentation. Lipofilling is a safe procedure in reconstructive and aesthetic breast surgery and can help to restore natural appearance, compensate volume deficiencies, and correct asymmetries, that may be congenital or a consequence of prior surgeries. Cosmetic breast augmentation of very small breasts or when aiming at higher breast volumes using lipofilling only are usually combined with procedures for tissue expansion in order to increase the take rate of the injected fat. Hyaluronic acid injections is no valid alternative and are not recommended for cosmetic breast augmentation.


Assuntos
Mamoplastia , Mastectomia , Satisfação do Paciente , Mama/cirurgia , Humanos , Silicones
7.
Anticancer Res ; 40(11): 6505-6511, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109590

RESUMO

BACKGROUND/AIM: This study aimed to investigate the bolus practice among Italian radiation oncologists. PATIENTS AND METHODS: In 2018, a survey on bolus application was sent to all members of the Italian Association of Radiotherapy and Clinical Oncology. RESULTS: The survey was joined by 102 radiation oncologists. Not all respondents answered to every question. A 69.5% of 82 respondents used bolus in case of skin infiltration and 52 of 68 respondents (76.5%) applied it every day. Skin was included as part of chest wall Clinical Target Volume both in the absence or the presence of breast reconstruction. Five mm bolus was the most used. 3D Conformal radiotherapy was the most used technique, in 73.5% of cases. Acute RTOG G2-G3 skin toxicity was recorded by 93.9% physicians. CONCLUSION: There was heterogeneity in the use of bolus, though an agreement was found in some topics. The achievement of a National Consensus may represent an interesting future goal.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Radioterapia Adjuvante/métodos , Pele/efeitos da radiação , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada , Relação Dose-Resposta à Radiação , Feminino , Humanos , Itália/epidemiologia , Mamoplastia , Mastectomia , Oncologia/tendências , Pessoa de Meia-Idade , Padrões de Prática Médica , Radio-Oncologistas , Radioterapia Conformacional , Pele/patologia , Parede Torácica/patologia , Parede Torácica/efeitos da radiação
9.
FP Essent ; 497: 27-36, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33021776

RESUMO

In 2018, breast augmentation was the most common cosmetic surgical procedure performed in the United States. It was the most commonly performed cosmetic surgical procedure in women ages 18 to 34 years. Silicone gel-filled implants are the most commonly used in the United States, followed by saline-filled implants. The most common approach to placement of implants is through an incision in the inframammary fold. The majority of implants are placed subglandularly, under the breast tissue but on top of the pectoralis muscle. Postoperative complications include lumps, asymmetry, leakage or deflation, capsular contracture, changes or loss of nipple and areolar sensation, seroma, hematoma, changes in breast shape, and infection. Long-term complications include infection, implant rupture, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Any patient who has undergone breast augmentation who presents with a breast lump or mass should be referred to a breast unit for evaluation. Lumps can indicate implant rupture, capsular contracture, seroma, hematoma, breast cancer, or infection. Studies have shown no association between silicone-filled breast implants and connective tissue disorders. Breast reconstruction after mastectomy frequently involves placement of implants. Autologous reconstruction remains another option. Various implants are approved by the Food and Drug Administration for buttock and calf augmentation.


Assuntos
Implantes de Mama , Neoplasias da Mama , Cirurgia Plástica , Adolescente , Adulto , Implantes de Mama/efeitos adversos , Feminino , Humanos , Mastectomia , Géis de Silicone , Estados Unidos , Adulto Jovem
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5394-5397, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019200

RESUMO

The breast cancer is a prevalent problem that undermines quality of patients' lives and causes significant impacts on psychosocial wellness. Advanced sensing provides unprecedented opportunities to develop smart cancer care. The available sensing data captured from individuals enable the extraction of information pertinent to the breast cancer conditions to construct efficient and personalized intervention and treatment strategies. This research develops a novel sequential decision-making framework to determine optimal intervention and treatment planning for breast cancer patients. We design a Markov decision process (MDP) model for both objectives of intervention and treatment costs as well as quality adjusted life years (QALYs) with the data-driven and state-dependent intervention and treatment actions. The state space is defined as a vector of age, health status, prior intervention, and treatment plans. Also, the action space includes wait, prophylactic surgery, radiation therapy, chemotherapy, and their combinations. Experimental results demonstrate that prophylactic mastectomy and chemotherapy are more effective than other intervention and treatment plans in minimizing the expected cancer cost of 25 to 60 years-old patient with in-situ stage of cancer. However, wait policy leads to an optimal quality of life for a patient with the same state. The proposed MDP framework can also be generally applicable to a variety of medical domains that entail evidence-based decision making.


Assuntos
Neoplasias da Mama , Adulto , Neoplasias da Mama/terapia , Humanos , Cadeias de Markov , Mastectomia , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5615-5618, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019250

RESUMO

Breast cancer is the most prevalent type of cancer in the US. Available treatments, including mastectomy, radiation, and chemotherapy, vary in curability, cost, and mortality probability of patients. This research aims at tracking the result of post-treatment for evidence-based decision making in breast cancer. Based on available big data, we implemented conditional probability to estimate multi-age transition probability matrices to predict the progression of disease conditions. The patient state is defined based on patients' age, cancer stage, and treatment history. To tackle the incomplete data in the matrix, we design a novel Hierarchical Gaussian Distribution (HGP) to estimate the missing part of the table. The HGP model leads to the lowest Root Mean Square Error (RMSE), which is 35% lower than the Gaussian Process and 40% lower than Linear Regression. Results of transition probability estimation show that the chance of survival within a year for 40 to 50 years old patient with the distant stage of cancer is 96.5%, which is higher than even younger age groups.


Assuntos
Neoplasias da Mama , Adulto , Neoplasias da Mama/terapia , Humanos , Mastectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Distribuição Normal , Probabilidade
12.
Acta Cir Bras ; 35(9): e202000907, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027362

RESUMO

PURPOSE: To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. RESULTS: Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. CONCLUSION: Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.


Assuntos
Antibioticoprofilaxia , Neoplasias da Mama , Infecção da Ferida Cirúrgica , Brasil , Neoplasias da Mama/cirurgia , Método Duplo-Cego , Feminino , Humanos , Mastectomia , Infecção da Ferida Cirúrgica/prevenção & controle , Estados Unidos
13.
Medicine (Baltimore) ; 99(43): e22795, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120797

RESUMO

RATIONALE: Postoperative acute respiratory distress syndrome (ARDS) often results in severe morbidity and mortality in surgical patients. The etiology of this condition is complex, especially in cancer patients. PATIENT CONCERNS: We encountered a 53-year-old woman with left breast cancer, cT1cN2M0, stage IIIA with left axillary lymph node metastasis. She had received chemotherapy with 4 cycles of doxorubicin plus cyclophosphamide, and 4 cycles of trastuzumab plus docetaxel within a span of 6 months. Subsequently, she underwent left simple mastectomy and axillary lymph node dissection, shortly after which she developed respiratory distress with progressive desaturation and hemoptysis. DIAGNOSIS: ARDS was diagnosed using the Berlin criteria. Her arterial blood gas analysis revealed profound hypoxemia and her chest imaging was suggestive of pulmonary edema. She developed diffuse alveolar hemorrhage (DAH) that was confirmed with bronchoscopy and hemorrhagic samples on bronchoalveolar lavage. INTERVENTIONS: She was mechanically ventilated with lung protective measures for management of ARDS. In addition to antibiotic cover with amoxicillin sodium-potassium clavulanate for occult infections during her stay in the intensive care unit, we administered epinephrine inhalations, intravenous treatment with tranexamic acid, and methylprednisolone for DAH. OUTCOMES: Her clinical course improved; she was extubated successfully on day 7 and discharged home on day 11. LESSONS SUBSECTIONS: Chemotherapeutic agents may cause pulmonary toxicity through a direct cytotoxic effect or immune-mediated reactions and result in an increased risk of development of ARDS. Furthermore, surgery may trigger a systemic inflammatory response syndrome that can also induce ARDS. In our patient, the development of ARDS was attributed to the combined effects of surgery and chemotherapeutic agents (trastuzumab or docetaxel). When patients undergo major surgery after receiving chemotherapeutic agents, careful consideration is necessary to prevent the development of ARDS.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Antibacterianos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Metástase Linfática , Mastectomia/métodos , Pessoa de Meia-Idade , Respiração Artificial/métodos
14.
15.
Anesth Analg ; 131(5): e230, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33094980
16.
PLoS One ; 15(10): e0237363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017425

RESUMO

OBJECTIVE: To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. METHODS: The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. RESULTS: A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). CONCLUSION: Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.


Assuntos
Mama/cirurgia , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Analgesia/métodos , Feminino , Humanos , Nervos Intercostais , Masculino , Mastectomia , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Segurança , Coluna Vertebral/inervação , Toracoscopia , Toracotomia , Resultado do Tratamento
19.
Rev Assoc Med Bras (1992) ; 66(8): 1134-1138, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32935810

RESUMO

Women with mutations in the BRCA 1 and 2 genes are at increased risk for ovarian and breast cancer and therefore candidates for risk-reducing surgery, including salpingo-oophorectomy and mastectomy. Risk-reducing salpingo-oophorectomy (RRSO) is considered the most effective prophylactic measure for ovarian cancer prevention in this group of patients. This procedure involves loss of ovarian function and induced menopause. Estrogen therapy is the most effective treatment for controlling vasomotor symptoms and improving the quality of life of climacteric women. However, the potential hormonal stimulation of these tumors and the risk of breast cancer are a concern regarding the safety of hormone replacement therapy (HRT) in this population. This article aims to review the current evidence regarding the potential benefits and safety of HRT after RRSO.


Assuntos
Neoplasias da Mama , Proteína BRCA1 , Proteína BRCA2 , Neoplasias da Mama/terapia , Feminino , Humanos , Mastectomia , Mutação , Neoplasias Ovarianas , Ovariectomia , Qualidade de Vida , Fatores de Risco , Salpingo-Ooforectomia
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