Meta-analysis of clinical prognosis of stage Ⅰ breast reconstruction after modified radical mastectomy / 中国医师进修杂志

Objective:To evaluate the clinical prognosis of stage Ⅰ breast reconstruction after modified radical mastectomy by using Meta-analysis.Methods:Wanfang Resource Database, Chinese Journal Full-Text Database, VIP Information Resource System, Chinese Scientific and Technological Journal Database, Cochrane Library, EMbase, PubMed were searched by computer. The retrieval time was from the establishment of each database to August 25, 2021. To collect clinical control test group (CCT) and randomized controlled trial(RCT) on breast reconstruction after radical mastectomy. The researchers independently searched the inclusion and exclusion criteria, screened and sorted them, evaluated them, extracted relevant data, and performed Meta-analysis with Rev man 5.3 software.Results:Twelve research were enrolled in this study.the Meta-analysis results showed that there were no significant differences in the local recurrence rate, distant metastasis rate, 3-year tumor free survival rate and complications between the patients performed stage Ⅰ breast reconstruction after modified radical mastectomy and the patients only performed modified radical mastectomy ( OR = 0.91, 95% CI 0.50 - 1.68, P = 0.77; OR = 0.66, 95% CI 0.42 - 1.06, P = 0.09; OR = 1.22, 95% CI 0.77 - 1.93, P = 0.40; OR = 0.91, 95% CI 0.58 - 1.41, P = 0.66). The quality of life score in the patients performed stage Ⅰ breast reconstruction after modified radical mastectomy was higher than that in the patients only performed modified radical mastectomy ( MD = 9.79, 95% CI 8.82 - 10.76, P<0.001). Conclusions:StageⅠbreast reconstruction after modified radical mastectomy can reduce the pressure of patients due to physical defects, help patients build up confidence and improve their quality of life.

Câncer de Mama e Eritrodermia: Relato de Caso / Breast Cancer and Erythroderma: Case Report / Cáncer de Mama y Eritrodermia: Relato de Caso

Introdução: A eritrodermia esfoliativa é um evento raro que está associado a diversas doenças como psoríase, eczemas, neoplasias malignas, uso de medicamentos, entre outras. Relato do caso: Paciente de 63 anos apresentou quadro de exantema difuso iniciado em janeiro de 2018, evoluindo com descamação generalizada da pele e formação de úlceras, sentindo calafrios. Não referiu histórico de câncer na família. Na anamnese, não houve relato de nenhum tipo de eczema, doença de pele preexistente ou uso de plantas medicinais. Foi identificada neoplasia maligna de mama do subtipo molecular luminal A, posteriormente. Após mastectomia com linfadenectomia, houve apenas melhora parcial do quadro da eritrodermia. Atualmente, em uso de doxorrubicina. Conclusão: A paciente apresentou quadro clínico inicial condizente com o que se espera de eritrodermia, que pode estar associada ao surgimento de neoplasia maligna de mama. O presente relato é importante, pois pode auxiliar em diagnósticos diferenciais para a eritrodermia, mesmo na vigência de um quadro clínico atípico.

Introduction: Exfoliative erythroderma is a rare event associated with several diseases such as psoriasis, eczema, malignant neoplasms, medication use, among others. Case report: A 63-year-old patient presented diffuse rash that started in January 2018, evolving with generalized skin desquamation and ulcer formation, with chills. Did not report family history of cancer. In the anamnesis, there was no report of any type of eczema, preexisting skin disease or use of medicinal plants. Malignant breast cancer of luminal A molecular subtype was identified later. After mastectomy with lymphadenectomy, there was only partial improvement in erythroderma. Currently using doxorubicin. Conclusion: The patient presented an initial clinical condition consistent with what is expected from erythroderma, which may be associated with the emergence of malignant breast neoplasm. The present report is important because it can help in differential diagnoses for erythroderma, even in the presence of an atypical clinical case.

Introducción: La eritrodermia exfoliativa es un evento raro asociado con varias enfermedades como psoriasis, eccema, neoplasmas malignos, uso de medicamentos, entre otros. Relato del caso: Paciente de 63 años presentó una erupción cutánea difusa que comenzó en enero de 2018, que evolucionó con descamación generalizada de la piel y formación de úlceras, con escalofríos. No informó antecedentes familiares de cáncer. En la anamnesis, no hubo informes de ningún tipos de eccema, enfermedad cutánea preexistente o uso de plantas medicinales. La neoplasia de mama maligna del subtipo molecular luminal A se identificó más tarde. Después de la mastectomía con linfadenectomía, solo hubo una mejoría parcial en la eritrodermia. Actualmente usa doxorrubicina. Conclusión: La paciente presentó un cuadro clínico inicial consistente con lo que se espera de la eritrodermia, que puede estar asociada con la aparición de neoplasma maligno de mama. El presente informe es importante porque puede ayudar en los diagnósticos diferenciales de eritrodermia, incluso en presencia de un cuadro clínico atípico.

The comparative study of endoscope versus open surgery on nipple sparing mastectomy with immediate reconstruction using prosthesis implantation / 中华外科杂志

Objective@#To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery.@*Methods@#Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 65 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients′ satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ2 test or non-parametric test.@*Results@#There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178±80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237±104) ml, t=-2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62±36) ml, t=3.210, P=0.002). Patients′ satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group.@*Conclusions@#Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.

Reconstrução mamária em mulheres jovens e suas peculiaridades / Breast reconstruction in young women and their peculiarities

Introdução: O objetivo do trabalho foi avaliar as principais características e métodos utilizados na reconstrução mamária de mulheres jovens, considerando suas peculiaridades. Métodos: Foi realizada uma revisão retrospectiva dos prontuários das pacientes submetidas à mastectomia seguida de reconstrução mamária no período de janeiro de 2008 a dezembro de 2015, sendo selecionados aqueles cuja reconstrução foi realizada em mulheres de até 40 anos de idade. Resultados: 43 pacientes foram selecionadas. A média de idade foi de 33,86 anos. Grande parte possuía alguma comorbidade, sendo as mais comuns o sobrepeso e o transtorno ansioso/depressivo. Quatorze pacientes tinham história familiar da doença. A maioria obteve o diagnóstico de carcinoma ductal invasor. Tratamentos oncológicos complementares foram realizados em grande parte dos casos. Todas as pacientes foram submetidas à mastectomia total na mama portadora da neoplasia, sendo que em 16 houve a opção pela mastectomia redutora de risco contralateral. Do total de 43 reconstruções, 36 foram imediatas e 7 tardias; sendo 17 reconstruídos com implantes mamários, 13 com expansores teciduais, 4 com TRAM e 9 com GD. Houve 15 complicações, sendo as mais graves um caso de infecção com perda da reconstrução e um caso de necrose de aréola. Conclusões: Mulheres jovens submetidas à reconstrução mamária representam um subgrupo populacional com características próprias. Os padrões tumorais, pessoais e sociais diferem e, com base nesta imensa lista de variáveis, as possibilidades de tratamento são diversas. Em nossa casuística, o emprego de implantes mamários e expansores teciduais foi realizado com maior frequência neste subgrupo de pacientes.

Introduction: To evaluate the main features and methods used in breast reconstruction in young women considering their unique characteristics. Methods: A retrospective records review of patients who underwent mastectomy followed by breast reconstruction between January 2008 and December 2015 was conducted, selecting those reconstructions that were performed in women younger than 40 years. Results: Forty-three patients were selected. The average age was 33.86 years. Many had some comorbidities, the most common being overweight and anxiety/ depressive disorder. Fourteen patients had a family history of the disease. Most were diagnosed with invasive ductal carcinoma. Additional cancer treatments were administered in most cases. All patients underwent a full mastectomy in the breast with cancer, and in 16, there was the option of contralateral risk-reducing mastectomy. Of the 43 reconstructions, 36 were immediate and 7 were delayed, and 17 involved use of implants, 13 involved use of tissue expanders, 4 involved the TRAM, and 9 involved the GD. We observed 15 complications; the most severe were infection with reconstruction loss in one patient and areola necrosis in another. Conclusions: Young women undergoing breast reconstruction represent a population subgroup with its own characteristics. The tumors and personal and social patterns differ, and based on this long list of variables, treatment options are diverse. In our series, breast implants and tissue expanders were often most used.

Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy / 中国医师进修杂志

Objective To investigate the effect of ultrasound-guided serratus plane block onefficacy of postoperative analgesia in patients undergoing radical mastectomy. Methods From January 2013 to December 2016, sixty-eight ASA physical statusⅠorⅡ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n = 34 each): SP block group (observation group) and control group. After induction of anesthesia, ultrasound-guided homolateral SP block was performed, and 0.375% ropivacaine 20 ml was injected in observation group, while the equal volume of normal saline was used instead in control group. The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in two groups. The scores of prince henry pain scale (PHPS) were evaluated at the 2nd, 4th, 8th, 12th and 24th hour (T1, T2, T3, T4, T5) after operation. The consumption of sufentanil, propofol and remifentanil was recorded.Meantime, the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up, and D1/D2 was calculated. The adverse effects were also recorded. Results The scores of PHPS at T1 [(1.4 ± 0.5) scores vs. (3.1 ± 0.6) scores], T2 [(1.5 ± 0.6) scores vs. (2.9 ± 0.8) scores], T3 [(1.7 ± 0.5) scores vs. (2.8 ± 0.7) scores], and the consumption of sufentanil [(53.4 ± 16.7)μg vs. (87.8 ± 24.5)μg], remifentanil[(288.7 ± 42.1)μg vs. (376.5 ± 61.6)μg] were significantly lower in observation group than those in control group, while D1/D2 (0.89 ± 0.12 vs. 0.57 ± 0.18) was higher (P<0.05). The incidence of adverse reactions was significantly lower in observation group: 0 vs. 20.6% (7/34), P<0.05. Conclusions Ultrasound-guided SP block reduces the perioperative opioids consumption and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

Effect of postoperatively early stage-function-exercise on recovery of upper limb function of diseased side after breast cancer modified radical mastectomy / 重庆医学

Objective To investigate the effect of postoperatively early stage-function-exercise on the recovery of upper limb function of diseased side after breast cancer modified radical mastectomy.Methods One hundred patients with breast cancer admitted to our hospital from January 2013 to June 2016 were collected.All patients underwent modified radical mastectomy.The patients were divided into the observation group and control group after operation,50 cases in each group.The observation group was given the early stage-function-exercise,while the control group received the routine nursing care.The shoulder joint mobility,affected limb edema degree,self-rating anxiety scale (SAS)score,self-rating depression scale (SDS) score and 36-item short-form health survey (SF-36) score were observed in the both groups.Results When compared with the control group,the patients in the observation group got a significant increase in the shoulder joint activity such as antexion,abduction,internal rotation,external rotation,adduction and rear protraction at postoperative 3,6-months (P0.05).However,when compared with the control group,the patients in the observation group got a significant decrease of upper limb volume at postoperative 3 months[(1 543.38±414.93) mL vs.(1 635.58±401.58) mL,P=0.000)],a significantly decrease of SAS score[(37.87±6.90) points vs.(44.07±12.32) points,P=0.000)] and SDS score[(38.32±6.65) points vs.(45.02±11.07) points,P=0.000)] at postoperative 6 months,and a significant increase of SF-36 score at postoperative 6 months [(77.52±7.28) points vs.(70.28±7.55) points,P=0.000)].Conclusion Postoperatively early stage-function-exercise can help to improve the shoulder joint activity degree and quality of life,and reduce the limb edema degree after modified radical mastectomy in the patients with breast cancer.

Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy / 中国医师杂志

Objective To investigate the effect of ultrasound-guided serratus plane (SP) block on efficacy of postoperative analgesia in patients undergoing radical mastectomy.Methods From February 2012 to October 2016,sixty American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n =30 each):SP block group (observation group) and control group.After induction of anesthesia,ultrasoundguided homolateral SP block was performed,and 0.375％ ropivacaine 20 ml was injected in observation group,while the equal volume of normal saline was used instead in control group.The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in the two groups.The scores of prince henry pain scale (PHPS) were evaluated at 2,4,8,12 and 24 hours (T1,T2,T3,T4,T5) after operation.The consumption of sufentanil,propofol and remifentanil were recorded,meantime the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up,calculating D1/D2.The adverse effects were also recorded.Results The scores of PHPS at T1 [(1.4 ± 0.6) scores vs (3.1 ±0.7) scores],T2 [(1.5 ±0.7) scores vs (2.9 ±0.9) scores],T3 [(1.7 ±0.6) scores vs (2.8±0.8) scores],and the consumption of sufentanil [(53.4 ± 16.8) μg vs (87.8 ±24.6) μg],remifentanil [(288.7 ±42.2) μg vs (376.5 ±61.7) μg] were significantly lower in observation group than in control group,while D1/D2 (0.89 ±0.13 vs 0.57 ±0.19) was higher (P ＜0.05).The incidence of adverse reactions was significantly lower in the observation group (0 vs 23.3 ％) (P ＜ 0.05).Conclusions Ultrasound-guided SP block reduces the consumption of perioperative opioids and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

The research progress on wound treatments of modified radical mastectomy / 中国医师杂志

It is easy to appear subcutaneous exudate or flap necrosis after modified radical mastectomy.The treatments of wound are the committed step for the healing after operation.Recent years,there are different methods about the treating of wound after modified radical mastectomy.This article reviewed the treatments of wound after modified radical mastectomy to prevent the complication occurrence,shorten the time of the healing,and create the advantages for the comprehensive treatment.

Adjuvant radiotherapy in breast cancer patients after radical mastectomy or modified radical mastectomy / 国际肿瘤学杂志

In recent years,the influencing factors of prognosis and effect after radiotherapy in breast cancer patients with radical mastectomy or modified radical mastectomy have gradually become a hot research,and it is closely related with the stages,subtypes,hormone levels and the body mass index (BMI).Otherwise,from three dimensional conformal radiation therapy to helical tomotherapy,the development of radiation technology has a breakthrough progress and makes the treatment of diseases more accurate and rational.

Clinical study of one-stage lymphatics-venous anastomosis to prevent upper extremity lymphedema of breast cancer after radical resection / 国际肿瘤学杂志

Objective To investigate the value of one-stage lymphatics-venous anastomosis in radical mastectomy of breast cancer to prevent post-mastectomy upper limb lymphedema.Methods Ninety patients requiring radical mastectomy of breast cancer in Tangshan Tumor Hospital Affiliated to North China University of Science and Technology from March 2010 to May 2013 were collected as the objects.They were divided into the control group (45 cases) and the treatment group (45 cases) using block randomized grouping (concealment of allocation).Both groups underwent radical mastectomy of breast cancer, and the treatment group was treated with one-stage lymphatics-venous anastomosis on the basis of radical mastectomy.The operation times, amount of bleeding, hospitalization times, postoperative complications and the numbers of axillary lymph node dissection of the patients in the two groups were compared, and the postoperative upper limb lymphedema incidence rates of the patients in the two groups were compared.Results The operative times of the patients in the treatment group and the control group were (152.82 ± 18.76) min and (78.92 ± 10.33) min respectively, and amount of bleeding were (416.64 ± 94.65) ml and (250.84 ± 63.17) ml, with statistical significances (t =-20.39, P =0.00;t =-4.48, P =0.00).The average hospitalization times of the patients in the treatment group and the control group were (14.91 ± 5.44) d and (13.45 ± 2.36) d respectively, the numbers of axillary lymph node dissection were 14.63 ± 3.37 and 14.37 ± 3.18, the numbers of postoperative complications occurred were 9 cases (20.00％) and 5 cases (11.11％), with no statistical significances (t =-0.47, P =0.64;t =0.75, P =0.46;x2 =1.35, P =0.38).Compared with the control group, the treatment group has lower incidence of upper extremity lymphedema (13.95％ vs.40.91％) and lower swelling degree, with statistical significance (x2 =8.48, P =0.03).Conclusion One-stage lymphatics-venous anastomosis in radical masteetomy of breast cancer can effectively transfer lymph diversion to the venous circulation and reduce the incidence of limb lymphedema, which has significant preventive effect.

Design of intensity modulated radiotherapy plan in chest wall and supraclavicular region for patients with breast cancer after radical mastectomy / 肿瘤研究与临床

Objective To study how to design the treatment plan to reduce the influence of respiratory movement and the dose of heart and lung as few as possible,to improve the dosage distribution in the target area after radical mastectomy of breast cancer.Methods Twelve patients with breast cancer after radical mastectomy were selected.A dose of 50 Gy with 2 Gy every day and 5 times per week was prescribed.Based on the treatment planning system (TPS),4-field intensity modulated radiotherapy (4FIMRT) and hybrid intensity modulated treatment planning 2-field conformal radiotherapy (2FCRT) + 4FIMRT were designed respectively.The two plans were compared from the aspects of target conformity index (CI),the homogeneity index (HI) and exposure dose volume delivered to organ at risk.Results According to the hybrid plan of 2FCRT + 4FIMRT,HI was 1.08±0.01,which was superior to that from 4FIMRT (1.11±0.01,t =9.587,P ＜ 0.05).While CI was 0.74±0.08,based on the plan of 2FCRT+4FIMRT,which was slightly lower than that from 4FIMRT (0.80±0.03,t =2.497,P ＜ 0.05).Considering the dose volumes on ipsilateral lung in two plans,the values of V5,V10,Dmean of 2FCRT+4FIMRT plan were significantly less than those of 4FIMRT plan.V5,V10,Dmean from the former plan were 13 ％,23 ％,7 ％ less than those from the latter plan (t =6.002,P ＜ 0.05;t =6.826,P ＜ 0.05;t =3.645,P ＜ 0.05).Meanwhile,Dmean of contralateral lung,Dmean of heart,Dmean and V5 of contralateral breast from the 2FCRT +4FIMRT plan were all lower than those of 4FIMRT plan.Those differences between two plans were statistically significant (P ＜ 0.05).Differences of V20 and V30 of ipsilateral lung,and V30 of heart between two plans did not make sense by the statistics analysis (P ＞ 0.05).Conclusion Hybrid radiotherapy theoretically reduces the influence of respiratory movement,improves the uniformity of target dose and lowers the risk of complications of radiation therapy on breast cancer.

Comparison of the effects of breast conservative therapy and radical mastectomy in treatment of patients with early stage breast cancer / 中国基层医药

Objective To compare the effects of breast conservative therapy and radical mastectomy in treatment of patients with early stage breast cancer.Methods 76 patients with early breast cancer,informed consent by themselves and their families were divided into breast conservative therapy group(BCT group,2 1 cases)and breast radical group(RT group,55 cases),and BCT group was conducted breast conserving surgery,and RT group Was given radical surgery of breast cancer.The two groups were all given conventional postoperative chemotherapy and endocrine therapy.Then the therapeutic effects and complications were observed and compared.Following up for 1 to 6 years,the recurrence was compared.Results All patients were cured.In BCT group,5 cases of subcutaneous fluid,2 cases offat liquefaction of incision,1 ease of wound infection,1 case of upper limb edema,and in RT group,8 cases of subcu-taneous fluid occurred,5 cases of wound fat liquefaction,2 cases of wound infection,3 cases of upper limb edema,and the difference of complication rate between the two groups had no significant difference(P＞0.05).The scores of quality life of BCT group were significantly higher than those of RT group(t=3.42,3.18,4.07,3.09,2.87,3.26,all P＜0.05).All patients were regularly followed up for 1 to 6 years,local recurrence rate and survival rate of BCT group Was 4.8%(1/21)and 95.2%(20/21),and those of RT group Was 3.6%(2/55)and 96.4%(53/55),and the difference of local recurrence rate and survival rate between the two groups had no statistical significance(all P＞0.05).Conclusion Breast conserving surgery for early breast cancer was safe and feasible without increasing the relapse rate,and could get a good quality of life.

Modified radical mastectomy preserving intercostobrachial nerve in clinical application / 中国基层医药

Objective To explore the early(Ⅰ,Ⅱ)in modified radical mastectomy of breast cancer clinical value of preserving intercostobrachial nerve.Methods A retrospective analysis of 62 cases of early breast cancer patients with the clinical data,on intraoperative complete preservation of the intercostobrachial nerve in 46 cases as the observation group,intraoperative resected intercostobrachial nerve in 16 cases as control group,comparative analysis of the two groups after the upper medial arm and axilla skin paresthesia and breast cancer recurrence.Results All 62cases underwent modified radical mastectomy of breast cancer,all patients were cured.The observation group upper medial arm and axillary skin sensory abnormalities in 5 cases(10.9％),significantly lower than the control group of 16 cases(100％)(x2 =19.27,P ＜0.05).A mean follow-up of 1 year,the observation group in upper arm skin party abnormalities in patients with 5 cases,after 1 ～ 3 mongths recovery ;control group of sensory abnormalities were not returned to normal; the two groups were not found in local tumor recurrence or distant metastasis.Conclusion In modified radical mastectomy of breast cancer reserving intercostobrachial nerve was feasible,and could significantly reduce the postoperative lateral medial arm and axilla skin feeling abnormal rate,and improve the quality of life in patients.

Cáncer oculto de mama: presentación de caso / Occult cancer of the breast: a case presentation

Fundamento: el cáncer mamario en una problemática creciente y desafiante para los servicios de salud en todo el mundo. Casos clínicos: se presenta la experiencia del diagnóstico y tratamiento del cáncer oculto de mama en tres pacientes en el Hospital Provincial Docente de Oncología de Camagüey. Esta enfermedad representa alrededor del 1 por ciento de todos los cánceres mamarios. Se muestra como una adenopatía ipsilateral sin nódulo mamario demostrable, el estadiamiento se hace dentro del sistema TNM tradicional con estadios que van desde una etapa IIb, hasta una IIIb. Hoy día se aplica una conducta quirúrgica diferente más centrada en el tratamiento de la axila, que evoluciona desde una mastectomía radical en cualquiera de sus variantes hasta sólo un vaciamiento axilar homolateral. En el Hospital Oncológico de Camagüey se diagnosticaron tres casos nuevos de carcinoma oculto de mama en los últimos dos años siendo tratadas diferente, debido a que la conducta frente a esta enfermedad sigue siendo controversial. Conclusiones: el presente trabajo demuestra la experiencia en el diagnóstico y tratamiento de esta enfermedad.

Background: breast cancer is a growing and defiant problem for health services in the entire world. Development: it is presented the experience on diagnosis and treatment of occult cancer of the breast at the Educational Provincial Oncology Hospital of Camagüey. This disease represents around 1 percent of all breast cancers. It is shown like an ipsilateral adenopathy without demonstrable mammary nodule; the staging is made inside the traditional TNM system with stages that goes from a IIb, until a IIIb. Nowadays a different surgical behavior is applied more centred in the treatment of the axilla that evolves from a radical mastectomy in any of its variants until only an homolateral axillary évidement. In the Oncological Hospital of Camagüey three new cases of occult carcinoma of the breast were diagnosed in the last two years which receive a different treatment, because the behavior in the face of this disease is still controversial. Conclusions: the present work demonstrates the experience in diagnosis and treatment of this disease.

Evolução oncológica de pacientes com carcinoma avançado de mama submetidas à reconstrução mamária imediata / Oncologic progression of patients with advanced breast carcinoma undergoing immediate breast reconstruction

Estudo retrospectivo de 119 pacientes com diagnóstico de adenocarcinoma ductal invasivo no estádio clínico III tratadas com quimioterapia neoadjuvante (FEC), mastectomia e adjuvância. Destas, 85 optaram por reconstrução mamária imediata (RMI) com retalho transverso músculo-cutâneo de reto-abdominal e 34, não. Com seguimento médio de 52,7 meses avaliou-se o tempo de hospitalização, a inter-relação com a adjuvância, recidiva local, o tempo livre de doença e o tempo total de sobrevida, concluindo-se que, apesar de aumentar o tempo de hospitalização, a RMI não interfere com os demais itens, podendo ser indicada para pacientes portadoras de carcinoma mamário em estádio clínico avançado.

A retrospective study with 119 patients diagnosed with invasive ductal adenocarcinoma of the breast treated with neoadjuvant chemotherapy (FEC), mastectomy and adjuvant therapy. Eight-five patients chose immediate breast reconstruction (IBR) with transverse rectus abdominis myocutaneous flap and, 34 did not do it. The mean follow-up was 52.7 months. Length of stay, adjuvant therapy interrelation, local recurrence, disease-free survival and overall survival were evaluated. It was concluded that despite a longer stay, IBR did not interfere with any of the other factors analyzed and may be indicated for patients with advanced breast disease.

Illness Experience of Women with Breast cancer in Korea: Using Feminist Phenomenology / 성인간호학회지

PURPOSE: The purpose is to explore the illness experience of Korean women with breast cancer using feminist phenomenology. METHODS: Data were collected by individual in-depth interviews from ten women with total mastectomy. The data were analyzed using Colaizzi's method from feminist perspective to reveal implicit socio-cultural norms that oppress women with breast cancer. RESULTS: Two categories and seven major themes emerged: cancer-related experience (1) unfairness of having breast cancer; (2) being confined to the gaze of the others; patriarchy-related experience (3) hardness of being daughter-in-law; (4) struggling to keep on being good mother; (5) continued housework as duty; (6) recognizing self as precious wife, and (7) awakening of true self. All participants felt it was very unfair to get breast cancer because they had done their best for roles of mother, wife, and daughter-in-law. They struggled to free themselves from the social disgrace like the roles imposed by the patriarchal society. By awakening their true selves, they could manage a balance between other-oriented life and self-oriented life. CONCLUSION: Oncology nurses need to provide psychosocial support for women with breast cancer in finding their true selves in a traditional patriarchal society where women are oppressed and breast cancer is stigmatized.

An analysis for 32 cases of cystosarcoma phyllodes / 中国基层医药

Objective To study the clinical characteristic of cystosarcoma phyllodes(CPS) for its types and name of pathology,diagnosis and treatment.Methods The clinical data of 32 cases of CSP were analysed.Results 7 cases of CSP were found recurrence in 13 cases of CSP who were treated by simple cystosarcomaectomy.2 cases of CSP were found recurrence in 17 cases of CSP who were treated by wide cystosarcomaeactomy.2 cases of CSP were treated by simple mastocarcinomaectomy and follow-up found no recurrence.Conclusions CSP is different from fibroadenoma and mastocarcinoma.Diadnosis is made by rapid refrigeration pathologic.Either wide cyctosarcomaectomy or simple mastocarcinomaeotomy is effective in treating CSP.

Cancer de mama: cirugía conservadora vs mastectomia radical / Breast cancer: conservative surgery versus radical mastectomy

Se realizó un estudio retrospectivo y comparativo tomando como universo 530 pacientes portadoras de cáncer de mama en las etapas I y II de la enfermedad, operadas en el servicio de Cirugía General del Hospital Clínico Quirúrgico "Abel Santamaría Cuadrado" de Pinar del Río, en el período de tiempo comprendido entre el 1ero. de Enero de 1988 y el 31 de Diciembre de 2003, las que fueron intervenidas por diferentes técnicas, 345 (65,09%) con proceder conservador y 185 (34,90%) con técnicas radicales (Patey, mastectomía total ampliada y mastectomía simple). El comportamiento de las recidivas locales fue significativo (p

Aimed at assessing breast cancer behaviour according to operative procedures a retrospective and comparative study was conducted taking as universe 530 female patients suffering from breast cancer (I and II stages of the disease) at Abel Santamaría University Hospital during the period of January 1st, 1998 and December 31, 2003 using different operative procedures, 345 (65.09 %) with conservative operative procedure and 185 (34.90 %) with radical mastectomy (Patey total wide mastectomy and simple mastectomy). Behaviour of local relapses was significant (p < 0.005) in favour of conservative operation 9.59 % and 18.37 % of radical operative procedures; a similar behaviour was present with distant metastases 8.11 % in those treated conservatively and 20.0 % in radical treatments. Global survival in 5 years favoured those patients who underwent conservative operation (90.47 %) in relation to those with radical mastectomy (73.64 %) p < 0.005.

Effect of radical mastectomy and extended radical mastectomy on stage II,III breast cancer:a report of 691 cases / 中国普通外科杂志

Objective To explore the therapeutic effects of radical mastectomy(RM) and extended radical mastectomy(ERM) for stage II, III breast cancer. Methods The 5 year and 10 year survival rates in 691 patients with stage II, III breast cancer treated either by extended radical mastectomy or radical mastectomy were retrospectively analyzed . Out of the 691 patients, 206 stage II cases and 193 stage III cases underwent RM, and 142 stage II and 150 stage III cases received ERM. Results In patients with stage II, III breast cancer located in the central portion or medial portion of mammary, the 5 year survival rates and in stage III patients 10 year survival rate after ERM were significantly higher than those after RM (P

The effect of ondansetron on the analgesic efficacy of tramadol for postoperative patient-controlled intravenous analgesia / 中华麻醉学杂志

Objective To investigate the effect of ondansetron on the analgesic efficacy of tramadol for postoperative patient-controlled intravenous analgesia (PCIA). Methods Forty ASA I - II patients aged 22-74 years, weighing 40-90 kg scheduled for radical mastectomy were randomly allocated to one of two groups : control group ( n = 20) and ondansetron group ( n = 20) . The patients were premedicated with intramuscular atropine 0.01 mg?kg-1 and diazepam 0.2 mg?kg-1. Anesthesia was induced with midazolam 0.1-0.2 mg (total dose was limited to 15 mg), fentanyl 2.4?g?kg-1 , propofol 1.5-2.0 mg?kg-1 and vecuronium 0.12-0.15 mg?kg-1 . The patients were mechanically ventilated after tracheal intubation (VT 8-10 ml?kg-1 , RR 13 bpm). Anesthesia was maintained with enflurane inhalation and continuous infusion of vecuronium. The patients were attached to a PCIA pump after operation and received PCIA with 1 % tramadol (background infusion 2 ml?h-1 , bolus dose 2 ml, lockout interval 10min) in both groups. In ondansetron group the patients received ondansetron 6 mg iv during operation and a loading dose of tramadol 1 mg?kg-1 and ondansetron 2 mg after operation before PCIA. Pain score (VAS 0-10), sedation score (0-3), tramadol consumption and the incidence of nausea and vomiting were recorded at 4, 8, 12 and 24 h after operation. Results There was no significant difference in pain and sedation scores and the incidence of vomiting between the two groups. Significantly more tramadol was consumed at 4, 8 and 12 h after operation in the ondansetron group as compared with control group (P