Depression and quality of life in patients with breast cancer undergoing chemotherapy and monoclonal antibodies.

BACKGROUND: Depression is one of the major psychiatric morbidities in cancer patients. The purpose of our study was to evaluate the impact of depressive symptoms in the quality of life (QoL) of patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments. METHODS: Observational, cross-sectional study conducted between April and November 2016. To evaluate the QoL, the EORTC QLQ-C30 and QLQ-BR23 questionnaire were used. The patients were screened for depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) and those with a positive HADS-D positive questionnaire were referenced to the Psychiatry and Mental Health Department for further assessment and follow-up. RESULTS: We included 45 female patients. Sixteen (35.6%) patients had a positive HADS-D questionnaire and depressive symptoms confirmed by a psychiatric physician. Of those patients, 7 (15.6%) had a major depressive episode confirmed by psychiatric interview. There was a significant association of depressive symptoms with the future perspectives scale (p = 0.022), breast symptoms scale (p = 0.011) and arm symptom scale (p = 0.005). Significant differences were found in the fatigue (p = 0.024), pain (p = 0.037) and dyspnea (p = 0.009) subscales being worse in patients with depressive symptoms. The association between having depressive symptoms or not was shown to be significant or marginally significant for the variables stage of the tumour (p = 0.057), presence of distant metastasis (p = 0.072) and previous diagnosis of depression (p = 0.011). The patients treated with regimens containing monoclonal antibodies presented better outcomes in various subscales of the EORTC QLQ-C30 and QLQ-B23 questionnaires than those patients treated with chemotherapy regimens without monoclonal antibodies. CONCLUSIONS: Despite the small sample of our study, this study provided evidence that depressive symptoms in patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments detrimentally reduced various aspects of QoL.

Laparoscopic resolution of intussusception after Roux-en-Y gastric bypass.

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) has been the most common surgical operation used to treat obesity and its inherent co-morbidities. Intussusception with bowel obstruction after RYGB is a rare complication and its physiopathology remains unclear. The diagnosis is generally based on typical image of computed tomography (CT) scan and a surgical exploration is generally recommended. CASE PRESENTATION: A 54-year-old female patient with history of a gastric bypass six years before, presented herself on the emergency department with acute onset of abdominal pain, nausea, and nonbilious vomiting. Her vital signs were stable. On abdominal evaluation a mass in the left flank was identified. The CT scan showed a small bowel intussusception. MANAGEMENT: Laparoscopic surgical exploration was performed and the diagnosis confirmed: retrograde jejunojejunal intussusception without vascular impairment. Reduction of the intussusception was possible without the need for bowel resection. A laparoscopic "second look" was made on the following day, revealing no signs of ischemia. There were no postoperative complications and the patient was discharged home on postoperative day 8. DISCUSSION: Intussusception after a RYGB is rare and the diagnosis is generally based on CT scan exam. Surgical exploration should be performed as soon as possible to prevent bowel ischemia and the need for resection.

Familial superior mesenteric artery syndrome.

Superior mesenteric artery syndrome (SMAS) has an incidence of 0.1-0.3%. It is caused by a narrow angle between the aorta and the superior mesenteric artery, resulting in the clamping of the third portion of the duodenum. It is more common in females (2:1), with no racial differences. It is also more frequent in patients under 30 years and may have a congenital or acquired aetiology. There is only one case of the familial form described in the medical literature. We present a case of a 20-year-old woman, with recurrent episodes of epigastric discomfort and vomiting since she was 10 years old. After clinical suspicion, diagnosis was achieved after digestive endoscopy, upper gastrointestinal transit and abdominal MR. The patient was kept under parenteral nutrition for 17 days before surgery. She was discharged 8 days after surgery and the postoperative course was uneventful.

Translation, adaptation and validation of a Portuguese version of the Moorehead-Ardelt Quality of Life Questionnaire II.

The prevalence of obesity has increased worldwide. An assessment of the impact of obesity on health-related quality of life (HRQoL) requires specific instruments. The Moorehead-Ardelt Quality of Life Questionnaire II (MA-II) is a widely used instrument to assess HRQoL in morbidly obese patients. The objective of this study was to translate and validate a Portuguese version of the MA-II.The study included forward and backward translations of the original MA-II. The reliability of the Portuguese MA-II was estimated using the internal consistency and test-retest methods. For validation purposes, the Spearman's rank correlation coefficient was used to evaluate the correlation between the Portuguese MA-II and the Portuguese versions of two other questionnaires, the 36-item Short Form Health Survey (SF-36) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite).One hundred and fifty morbidly obese patients were randomly assigned to test the reliability and validity of the Portuguese MA-II. Good internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.80, and a very good agreement in terms of test-retest reliability was recorded, with an overall intraclass correlation coefficient (ICC) of 0.88. The total sums of MA-II scores and each item of MA-II were significantly correlated with all domains of SF-36 and IWQOL-Lite. A statistically significant negative correlation was found between the MA-II total score and BMI. Moreover, age, gender and surgical status were independent predictors of MA-II total score.A reliable and valid Portuguese version of the MA-II was produced, thus enabling the routine use of MA-II in the morbidly obese Portuguese population.