Sobrepeso e obesidade entre mulheres e associação com características demográficas e obstétricas entre usuárias de uma unidade de saúde especializada / Overweight and obesity between women and association with demographic and obstetric characteristics among users of a specialized health unit

Resumo Introdução O excesso de peso é um fator de risco para doenças crônicas. Objetivo Estimar a prevalência de sobrepeso e obesidade, e investigar sua associação com variáveis demográficas, socioeconômicas e reprodutivas e com comportamentos relacionados à saúde entre mulheres usuárias de unidade de atenção especializada. Método Estudo transversal com mulheres em atendimento por mastologista. O estado nutricional foi classificado por meio do índice de massa corporal. Foram utilizados modelos de regressão logística multinomial brutos e ajustados, com estimativa de razões de chance (RC) e intervalos de confiança de 95% (IC95%). A eutrofia foi considerada como categoria de referência. Resultados Participaram 182 mulheres com média de idade de 51 anos. A prevalência de sobrepeso foi de 34,1% (IC95% 27,1-41,0) e de obesidade foi de 31,8% (IC95% 25,0-38,7). Apresentaram maiores chances de obesidade as mulheres: com 60 anos ou mais, que exerciam atividade remunerada, que tiveram menarca antes dos 13 anos e com três ou mais gestações. Após análise ajustada, permaneceram associadas à maior chance de obesidade a menarca antes dos 13 anos (RC 4,40; IC95% 1,76-10,99) e três ou mais gestações (RC 8,50; IC95% 2,14-33,70). Conclusão Verificou-se elevada prevalência de sobrepeso e obesidade entre as participantes, associada às características reprodutivas.

Abstract Background Overweight is a risk factor for chronic diseases. Objective To estimate the prevalence of overweight and obesity and to investigate its association with demographic, socioeconomic, reproductive and health behaviors related among women users of specialized care units. Method Cross-sectional study with women in care by a mastologist. Nutritional status was classified by Body Mass Index (BMI). Gross and adjusted multinomial logistic regression models were used, to estimate an Odds Ratios (OR) and 95% Confidence Intervals (95% CI). Eutrophy was considered as a reference category. Results 182 women with a mean age of 51 years. The prevalence of overweight was 34.1% (CI 95% 27.1-41.0) and obesity was 31.8% (CI 95% 25.0-38.7). Women were more likely to be obese: 60 years of age or older, who were gainfully employed, who had menarche before age 13, and with three or more pregnancies. After adjusted analysis, they remained associated with a greater chance of the development of obesity to menarche before 13 years (OR 4.40 CI 95% 1.76-10.99) and three or more pregnancies (OR 8.50 CI 95% 2.14-33.70). Conclusion There was a high prevalence of overweight and obesity among the participants, associated with reproductive characteristics.

Câncer de mama associado à gestação / Pregnancy-associated breast cancer

O câncer da mama é o tipo de câncer que mais acomete as mulheres em todo o mundo, tanto em países em desenvolvimento quanto em países desenvolvidos. Aproximadamente uma a cada 1.000 gestações que chegam ao termo serão complicadas pelo câncer. O câncer de mama está entre as neoplasias mais frequentes nesse grupo de mulheres. No entanto, apesar do aumento do diagnóstico e do desafio de seu tratamento durante a gravidez, os dados disponíveis na literatura até o momento são escassos. A presente revisão tem o objetivo de analisar os dados disponíveis até o momento, o tratamento proposto para estas pacientes e as possíveis repercussões desse tratamento tanto para as gestantes como para os fetos.(AU)

Breast cancer is the most common type of cancer among women all over the world, even in developed countries or in emerging countries. Nearly one in 1,000 pregnancies that leads to labour will be complicated by cancer, and pregnancy-associated breast cancer is the most common type encountered in this group. Although, despite the emerging number of cases being diagnosticated and the challenge of treating pregnancy-associated breast cancer, there are a few data about it until the present moment. This paper aims to review the data available until the present moment, about the treatment and possible effects envolving the pregnant mother and the fetus.(AU)

Enfoque comunitario y preventivo de las mastopatías / Community and preventive approach of the mastopathies

Las mujeres por el interés que prestan a su integridad física y espiritual, hacen especial cuidado de su salud y brindan atención a diferentes partes de su cuerpo. Constituyen motivo frecuente de consulta, procesos patológicos tanto benignos como malignos (mastopatías), que afectan el tejido mamario y son un problema de salud. Teniendo en cuenta la importancia del enfoque preventivo y comunitario de esta problemática, se realizó una revisión documental sobre el tema, con el objetivo de describir las acciones de salud dirigidas a la disminución de los indicadores de morbilidad y mortalidad por mastopatías. Se utilizaron para esto los métodos teóricos de análisis-síntesis e inducción-deducción

Women due to interest related to its physical and spiritual integrity, pay attention to its health and also t o different parts of its body. However, this is the frequent reason for consultation of the pathologic, benign and malignant (mastopathies) involving the breast tissue and are a serious health problem. Taking into account the significance of preventive and community approach to describe the health actions directed to decrease of indicators of morbility and mortality from mastopathies. Theoretical methods of analysis-synthesis and induction-deduction were used

Hamartoma folículo-sebáceo cístico simulando nódulo mamário: relato de caso / Folliculosebaceous cystic hamartoma simulating breast nodule: a case report

O presente artigo tem por objetivo relatar um caso de um paciente do sexo masculino, de 35 anos de idade, apresentando tumoração na mama esquerda. Após estudo pelos métodos de imagens habituais o paciente foi submetido a biópsia, que revelou o resultado de hamartoma folículo-sebáceo cístico. Os autores apresentam breve revisão da literatura científica sobre essa rara lesão na mama masculina e seu diagnóstico diferencial com lesões malignas.

We report a case of 35 year-old male patient presenting with a mass in the left breast. After conventional imaging examinations the patient was submitted to a biopsy, which showed folliculosebaceous cystic ham-artoma. The authors present a brief review of the literature on this rare lesion in the male breast and its differential diagnosis with malignant masses.

Analysis of mastalgia cases presented at Manipal Teaching Hospital, Pokhara, Nepal.

Breast pain (Mastalgia) is a common cause of anxiety among women and frequently leads to a primary care clinic for consultation. This study has been designed to study about mastalgia cases presented at Manipal Teaching Hospital, Pokhara. A total of 221 female patients with breast pain presented at outpatient department of surgery from Jan 2000 to Dec 2001 were enrolled in this study. Overall 36.8% presented with cyclical mastalgia and 43.1% with noncyclical mastalgia. Nonhormonal therapy like reassurance, breast support, reduction in dietary fat intake, VitE, Vit B6 was preferred for initial therapy of mastalgia as it was found to be associated with improvements of cyclical mastalgia and good compliance. Non cyclical mastalgia mostly presented with breast lump and ended with excision of lump.

Tratamento cirúrgico da gigantomastia / Surgical Treatment of Gigantomastia

Mastoplastia redutora é um procedimento cirúrgico bastante requisitado por pacientes que apresentam mamas grandes associadas a dores lombres. As grandes hipertrofias impõem técnicas que permitam ressecções associadas ao tratamento da ptose que, na maior parte dos casos, é acentuada. Neste estudo analisamos as técnicas empregadas em 231 casos de mastoplastia redutora, realizados no Serviço de Cirurgia Plástica do Hospital de Clínicas da UFPR no período de 1998 a 2002, das quais 13,8 foram considerados casos de gigantomastia.

Women with big breasts and back pain claim for a reduction mammaplasty. Large volume breast reductions need special atention for the nipple areolar complex migration. In this study we analise the techniques used in 231 reduction mammaplasties performed at “Hospital de Clínicas da Universidade Federal do Parana” from 1998 to 2002. 13,8 of the cases where considered with very large hipertrophies.

Hipertrofia masiva de la glándula mamaria. Presentación de seis casos / Massive hypertrophy of mammary gland. Presentation of six cases

En el período de enero de 1985 a enero de 1995, se diagnosticaron seis casos de hipertrofia masiva de la glándula mamaria de un total de 60,000 pacientes vistas en Consulta Externa del Servicio de Oncología Ginecológica. La edad osciló entre los 11 y los 27 años, con un promedio de edad de 20.8 años. Un caso fue unilateral y los cinco restante bilaterales, habiendo coexistido tres con embarazo. El tratamiento consistió en mastoplastía reduccional. Esta patología es una entidad rara, de etiología no bien definida en la cual al parecer se encuentran involucrados receptores hormonales y una sensibilidad inusual a hormona aunque se encuentren niveles séricos normales de las mismas

Nipple discharge: a prospective study of 1683

A prospective evaluation of 1683 women with Nipple Discharge at Breast Diseases Diagnostic Center, Department of surgery, Dow Medical College and Civil Hospital, Karachi over a five year phase i.e. 1991-1995, revealed it to be from multiple ducts in 1414 [84%] women and from a single duct in 269 [16%] cases. Majority [81%] of women were over 30 years of age. Most [80.5%] nipple discharges were surgically non-significant and were treated conservatively while 328[19.5%] underwent microdocbectomy or subareolar excision of the major ducts for tissue hisopatbology. Thirty nine [11.9%] cancer were detected and 147 [44.8%] intraductal popillomas were diagnosed whereas 101 [30.8%] women bad fibrocystic disease and 41 [12.5%] duct ectasia. Diagnostic aids were of great value, but not 100% accurate in differentiating benign from malignant lesions. Mammography bad a false -ve rate of 9% and a false +ve rate of 1.5% and was non-conclusive or suspicious in another 8%. Galactography had a limited ability to identify cancer from intraductal papilloma. It was a time consuming procedure and was uncomfortable to be patient. Cytology had a false -ve rate of 18% and a false +ve rate of 2.5%, in addition biopsies were recommended in another 12% for cytological atypia

overview of breast cancer

Breast cancer is a major health problem in many parts of the world. Its impact in Saudi Arabia will be more obvious when the national data is released from the National Cancer Registry [NCR] in the future. It is the most common cancer referred to the King Faisal Specialist Hospital and Research Centre [KFSH and RC]. This is a retrospective review of all female breast cancer cases treated at KFSH and RC over a 15-year period. Patients were divided into two groups at the time of their referral to KFSH and RC: metastatic and nonmetastatic. We describe the demographic data, cancer-related information and the treatment offered to all patients. Comparisons were made between Saudi and non-Saudi, and the Saudis were examined in relation to their region of referral and observed to see if any changes occurred during the study period. As well, we tried to compare our results with experience elsewhere. A total of 1584 female breast cancer patients were treated at KFSH and RC between 1975 and 1991. Early breast cancer [Stages I, II] represented 36%, while 64% presented with advanced or metastatic disease [Stages III, IV]. The majority of patients were premenopausal [64%]. For patients with Stage I=III [1005], mastectomy was performed in 85% and lymph node dissection in 93%. Only 30% had no pathologic lymph node involvement and in 49% of the patients, lymph node dissection was adequate [>/= 10 nodes removed]. Estrogen and progesterone receptors were known in 30% of the patients. Sixty-two percent and 72% of patients referred from the central region and the northern region had Stages II and III, respectively. For the non-Saudis, we observed more premenopausal patients [76%] and fewer Stage III, At 15 years, the relapse-free survival in Stages I, II and III was 33%, and 18%, and the overall survival was 80%, 64% and 45%, respectively. Breast cancer in this population affects younger patients [premenopausal] and a higher proportion present with metastatic or locally advanced disease. Management strategies should incorporate conservative surgery when appropriate, and adequate lymph node dissection. This should be coupled with increasing public awareness and education and institution of screening programs. Overall survival is clearly linked to the stage of the disease

Evaluación del diagnóstico clínico, la aspiración citología con aguja fina y la mamografía, en lesiones palpables de la glándula mamaria

El análisis de 322 lesiones palpables de la mama, con estudio histo-patológico, mostró alta sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo, a la combinación del diagnóstico clínico y la aspiración citología con aguja fina, y a la de éstas con la mamografía

Citologia por puncion aspiracion con aguja fina. Estudio de 514 casos / Fine needle cytology. Study of 514 cases

En 1075 muestras por puncion aspiracion para estudio citologico en el laboratorio de citologia del Hospital Nro. 1 CNS 514 fueron obtenidos por puncion-aspiracion con aguja fina. En 267 muestras de mama los resultados fueron correctos, en el 88.3 por ciento descartandose 9 muestras insuficientes o inadecuadas en los cuales de lesiones mamarias, un 55 por ciento fueron positivas para neoplasia maliagna. En 247 muestras de lesiones de tiroides se descartaron 28 por ser insuficientes e inadecuadas, siendo el 97.2 por ciento el nuemro de casos correctamente diagnosticados. De las 13 neoplasias diagnosticadas el 86.5 por ciento correspondio a un carcinoma papilar y el 1.5 por ciento al carcinoma anaplasico.

Conocimientos, actitud y conducta sobre el autoexamen de mama en las profesionales de Salud del Hospital Goyeneche, Arequipa

OBJETIVO: Determinar el nivel de conocimientos, conducta y actitudes de los profesionales de la salud sobre el autoexamen de mama. DISEÑO: Transversal, analítico. MUESTRA: Constituída por 83 profesionales de la salud de sexo femenino: 9 médicas, 58 enfermeras, 16 obstetrices. LUGAR DE REALIZACION: Hospital de Apoyo Goyeneche. RESULTADOS: La mayoría de los profesionales de salud tiene regular conocimiento del AEM(51.81 por ciento), teniendo el grupo de médicas(66.67 por ciento) buen conocimiento. Más de la mitad de profesionales de salud 69.88 por ciento se realiza el AEM ocasionalmente. 14.46 por ciento nunca, sólo un 15.66 por ciento realiza este examen mensualmente. No influye el tipo de ejercicio profesional en la frecuencia y enseñanza del AEM. El mayor obstáculo para la realización mensual del AEM es la falta de tiempo en un 50 por ciento. Más de la mitad(63.86 por ciento) sí enseña la técnica de AEM. Son suceptibles a desarrollar cáncer de mama(54.22 por ciento), estan conscientes de la gravedad del cáncer de mama(79.52 por ciento), la mayoría considera los beneficios del AEM(97.59), no ponen obstáculos(74.70 por ciento) para la realización del AEM; están motivados para una buena salud el 75.90 por ciento. CONCLUSIONES: Los profesionales de Salud tienen conocimientos regulares sobre AEM; sólo se realiza el AEM mensualmente el 15.66 por ciento; hay conciencia de la importancia y beneficios de una buena salud y del AEM así como la gravedad del cáncer de mama, sin embargo se realizan el AEM con poca frecuencia

Interpretación clínica de la mastalgia / Clinic interpretation of mastalgia

En los consultorios de la especialidad, el motivo más frecuente de consulta es el dolor mamario, y en virtud que las clasificaciones vigentes en cuanto a patología benigna generalmente no conllevan una orientación clínica, creímos oportuno poner a consideración una clasificación, que a nuestro entender, permite la interpretación de la mastalgia, en la certeza que existe un dolor que tiene origen en la mama (mastalgia genuina), y otro, que a pesar de estar referido a la mama es la expresión de patologías extraglandulares (mastalgia refleja). Dentro de las "mastalgias genuinas", hay dolores que tienen un comportamiento cíclico (mastalgias genuinas cíclicas), dentro de ellas, algunas "fisiológicas" (mastalgia premenstrual) y otras "patológicas". Estas últimas clínicamente se pueden acompañar de induraciones difusas (parcial o total), o pueden ser nodulares (macro o micronodulares). Existen, en cambio, "mastalgias genuinas no cíclicas", con variantes también "fisiológicas" (en el embarazo y la lactancia), y "patológicas" (traumatismos, infecciones, tumores). Entendemos por "mastalgias reflejas" los dolores referidos a la cara anterolateral del tórax, que pueden manifestarse como verdaderas mastalgias, pero que obedecen etiológicamente a diversas causas extramamarias (patología del raquis cérvico-dorsal, traumatismos, neuralgias, mialgias, flebitis, hiperuricemias, síndrome de Pancoast, herpes-zoster, síndrome de Tietze). Creemos que esta orientación clínica de las mastalgias permitirá un adecuado diagnóstico y por ende la terapéutica adecuada.