ABSTRACT
ABSTRACT BACKGROUND: Use of mammary adenectomy for breast carcinoma treatment remains controversial. OBJECTIVE: This study aimed to verify the oncological safety of mammary adenectomy and immediate breast reconstruction for treating selected patients with infiltrating breast carcinoma and to evaluate patients' satisfaction with the reconstructed breasts. DESIGN AND SETTING: Cohort study conducted among patients treated at Hospital Sírio-Libanês, São Paulo, Brazil. METHODS: This study was based on 152 selected patients (161 operated breasts) with infiltrating breast carcinoma who underwent mammary adenectomy and immediate breast reconstruction. In all patients, the diameter of the largest focus of the tumor was less than 3.0 cm, the imaging tumor-nipple distance was greater than 2.0 cm and the pathological assessment showed clear margins. The cumulative incidence of local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method. After at least one year of follow-up, 64 patients were asked about their satisfaction with the reconstructed breast(s). RESULTS: At a mean follow-up time of 43.5 months, seven cases of LR (4.4%), four distant metastases (2.6%) and five deaths (3.3%) were recorded. The five-year actuarial LR-free survival, RFS and OS were 97.6%, 98.3% and 98.3%, respectively. No cases of nipple-areolar complex recurrence were reported. Forty-one patients (64%) indicated a high level of satisfaction with the reconstructed breasts. CONCLUSIONS: Mammary adenectomy is a safe and efficacious procedure for selected patients with early-infiltrating breast carcinoma and results in a high rate of patient satisfaction with the reconstructed breasts.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast Neoplasms/surgery , Patient Satisfaction , Mammaplasty/methods , Carcinoma, Ductal, Breast/surgery , Retrospective Studies , Cohort Studies , Follow-Up Studies , Treatment Outcome , Disease-Free Survival , Mastectomy/methods , Neoplasm Recurrence, LocalABSTRACT
O linfoma anaplásico de células grandes (ALCL) associado a implantes mamários é um distúrbio linfoproliferativo das células T que foi recentemente reconhecido como uma entidade independente na classificação de linfomas da Organização Mundial de Saúde (OMS). Apesar do pequeno número de descrições, o número de casos está crescendo rapidamente. Das poucas centenas de casos que foram publicados até agora, muito poucos vieram do Brasil e nenhum foi relatado às autoridades locais. Encontramos um caso recentemente, e acreditamos que seu relato à comunidade local de cirurgia plástica poderá chamar a sua atenção para essa patologia emergente. O prognóstico é muito bom na maior parte dos casos diagnosticados. Contudo, ainda se sabe pouco sobre como e por que os implantes de silicone poderiam desencadear uma resposta linfoide, culminando num ALCL.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell lymphoproliferative disorder that has recently been recognized as an independent entity in the World Health Organization (WHO) classification of lymphomas. Despite the small number of reports to date, the number of cases is rapidly increasing. Of the few hundred cases that have been reported so far, very few came from Brazil and none have been reported to the local authorities. We encountered a case of BIA-ALCL and believe that its report to the local plastic surgery community could raise awareness to this emerging pathology. The prognosis is very good in most of the diagnosed cases. However, little is known about how and why silicone implants could trigger a lymphoid response that results in ALCL.
Subject(s)
Humans , Female , Adult , History, 21st Century , Breast Neoplasms , Mammaplasty , Lymphoma, Large-Cell, Anaplastic , Breast Implants , Plastic Surgery Procedures , Seroma , Breast Neoplasms/surgery , Breast Neoplasms/therapy , Mammaplasty/methods , Lymphoma, Large-Cell, Anaplastic/surgery , Lymphoma, Large-Cell, Anaplastic/therapy , Breast Implants/adverse effects , Plastic Surgery Procedures/methods , Seroma/surgeryABSTRACT
As fraturas da face em crianças são infrequentes e a melhor forma de tratamento ainda é a prevenção. Com isso nosso estudo busca caracterizar epidemiologicamente as fraturas de face em crianças enfatizando os sítios principais. Analisamos 126 fraturas de face em 98 crianças atendidas no Hospital das Clínicas-Faculdade de Medicina da Universidade de São Paulo, entre janeiro de 1990 e julho de 1996. A causa mais frequente foi a queda de alturas e o osso da face mais acometido foi a mandíbula (29 por cento), seguida do osso nasal (24 por cento). Das fraturas da mandíbula, o corpo foi a região mais envolvida (31 por cento), seguido do côndilo (27 por cento). Traumas associados estiveram presentes em 24 por cento dos casos, sendo traumatismo crânio-encefálico o mais frequente. Os acidentes domésticos são as principais causas de fraturas de face em crianças, portanto, medidas preventivas simples podem ser adotadas objetivando diminuir o número desses acidentes