RESUMO
In three men, aged 81, 66 and 58 years, breast cancer was diagnosed. All three were treated by modified radical mastectomy and axillary-node dissection. They received tamoxifen and the first and the third patient also received radiotherapy. Presentation of these patients is usually delayed, because of the rarity of and unfamiliarity with the disease. Consequently, the disease is often in a more advanced stage at presentation and overall mortality is higher in comparison with women with breast cancer. However, survival of male patients is similar to survival of female patients when matched for age and stage. This stresses the importance of a timely diagnosis. As in women, of the known risk factors for male breast cancer, a positive family history is one of the most important ones. Modified radical mastectomy, combined with sentinel-node biopsy by experienced teams, is the standard treatment. Criteria for adjuvant systemic treatment are identical for men and women, although hormonal therapy (tamoxifen) has a more prominent place in the adjuvant setting because of the high percentage of positive hormone receptors in men.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama Masculina/diagnóstico , Tamoxifeno/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama Masculina/tratamento farmacológico , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Quimioterapia Adjuvante , Terapia Combinada , Humanos , Metástase Linfática , Masculino , Mastectomia Radical Modificada , Pessoa de Meia-Idade , Radioterapia Adjuvante , Fatores de Tempo , Resultado do TratamentoRESUMO
A 33-year-old woman was trapped in a car following an accident. Because of her size (241 kg; BMI: 85 kg/m2) it was difficult to free, transport, examine and treat her. A few days after she had been discharged with a knee injury, she was again admitted for pneumonia. Partly as a result of para-infectious rhabdomyolysis, she died 5 days later. More and more people in The Netherlands are overweight, and more and more often to an extreme degree. Complicated accident kinetics, problems with diagnosis and treatment, comorbidity and an increased risk of complications in obese patients contribute to the poorer prognosis following blunt trauma. It is therefore practically impossible to give obese patients the usual care according to the protocol. Adaptations like positioning in the anti-Trendelenburg, left lateral-tilt position, as well as bigger and stronger equipment, may improve the care of trauma patients with morbid obesity.