ABSTRACT
OBJECTIVES: To assess the changes in shoulder strength of patients with breast cancer during the first year after surgery; and to compare the effect of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) on shoulder strength. DESIGN: Prospective longitudinal observational study from presurgery to 1 year after. SETTING: Tertiary hospital. PARTICIPANTS: Of 129 consecutive patients examined for eligibility, a sample of women (N=112) with breast cancer were included (44 underwent ALND, and 68 underwent SLNB). INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Difference between the affected and unaffected arm in strength of shoulder external rotators, internal rotators, abductors, and serratus anterior, measured by dynamometry. Evaluations were performed prior to surgery and at 1, 6, and 12 months after surgery. RESULTS: After breast cancer ALND surgery, strength decreased significantly at the first month for internal rotators, without having recovered presurgery values after 1 year of follow-up, with a mean difference of 2.26kg (P=.011). There was no significant loss of strength for patients treated with SLNB. The loss of shoulder range of motion was only significant the first month for the ALND group. The factors identified as associated with strength loss in the general estimating equation models were the ALND surgery and having received physical/occupational therapy during follow-up. CONCLUSIONS: One year after breast cancer surgery, patients treated with ALND had not recovered their previous shoulder internal rotators strength, whereas those who underwent SLNB presented no significant loss of strength. This provides important information for designing rehabilitation programs targeted specifically at the affected muscle group after nodal surgical approach.
Subject(s)
Axilla , Breast Neoplasms/surgery , Lymph Node Excision/adverse effects , Muscle Strength/physiology , Sentinel Lymph Node Biopsy/adverse effects , Shoulder/physiopathology , Aged , Disability Evaluation , Female , Humans , Longitudinal Studies , Middle Aged , Muscle Strength Dynamometer , Muscle, Skeletal/physiopathology , Physical Therapy Modalities , Prospective Studies , Range of Motion, Articular , Tertiary Care Centers , Time FactorsABSTRACT
INTRODUCTION: Screening programs for breast cancer aim to allow early diagnosis, and thus reduce mortality. The aim of this study was to assess the effect of a population screening program in a sample of women aged between 50 and 69 years in terms of recurrence, metastasis, biological profiles, and survival, and to compare their results with those of women of a wider age range who did not participate on the screening program. PATIENTS AND METHODS: A prospective multicenter study in which 1821 patients with 1873 breast tumors who received surgery between 1999 and 2014 at MútuaTerrassa University Hospital and the Hospital of Terrassa in Barcelona were analyzed. A comparison was performed in the 50- to 69-year-old age group between those who participated on the screening program and those who did not. RESULTS: The mean age of patients was 58 years. The mean follow-up was 72 months, and median follow-up 59 months. The screened group showed significantly better results in all prognostic factors and in specific mortality than all nonscreened groups. The specific mortality rate in the screened patients was 2.4% (12/496), local recurrence 2.8% (14/496), and metastasis at 10 years 3.6% (18/496). In the nonscreened group, younger women presented a higher rate of metastasis (16.4% [81/493]) and a shorter disease-free period (77.1% [380/493]). The age group older than 70 years had the highest number of T4 tumors (7.5% [30/403]) and the highest proportion of radical surgery (50.4% [203/403]). CONCLUSION: Patients in the screening program presented improved survival. We speculate that extending breast cancer screening programs to women younger than 50 and older than 70 years could bring about mortality benefits.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , Early Detection of Cancer , Age Factors , Aged , Female , Humans , Mammography , Middle AgedABSTRACT
Blood-stained colostrum occurs occasionally during pregnancy and lactation due to a conspicuous increase in lobuloalveolar growth. We report on a case of bilateral frank blood-stained colostrum secreted during pregnancy and early postpartum, emphasizing the transitory nature of this condition and the need to reinforce breastfeeding.
Subject(s)
Breast Feeding , Colostrum/cytology , Milk, Human/cytology , Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Trimester, ThirdABSTRACT
OBJECTIVE: To compare the effectiveness of a new interactive virtual telerehabilitation system and a conventional programme following total knee arthroplasty. DESIGN: Randomized, controlled, single-blind clinical trial. PARTICIPANTS: A total of 142 total knee arthroplasty patients. METHODS: Participants were randomly assigned to receive either: (i) conventional out-patient physical therapy; or (ii) interactive virtual telerehabilitation system. The main outcome was function assessed with active range of knee movement. Other variables, such as muscle strength, walk speed, pain and the Western Ontario and McMaster Universities osteoarthritis index, were also collected. Comparisons were made on the basis of data collected routinely before surgery, at the end of the rehabilitation programme, and at 3 months follow-up. Quantitative variables were compared by Mann-Whitney U test. The agreed alpha risk for all hypothesis testing was 0.05. RESULTS: Baseline characteristics between groups were comparable. All participants improved after the 2-week intervention on all outcome variables (p < 0.05). Patients in the interactive virtual telerehabilitation group achieved improvements in the functional variables similar to those achieved in the conventional therapy group. CONCLUSION: A 2-week interactive virtual telerehabilitation programme is at least as effective as conventional therapy. Telerehabilitation is a promising alternative to traditional face-to-face therapies after discharge from total knee arthroplasty, especially for those patients who have difficulty with transportation to rehabilitation centres.
Subject(s)
Arthroplasty, Replacement, Knee/rehabilitation , Telemedicine/methods , Aged , Ambulatory Care , Female , Humans , Male , Physical Therapy Modalities , Range of Motion, Articular , Recovery of Function , Single-Blind Method , Treatment Outcome , User-Computer InterfaceSubject(s)
Spouses/history , Caregivers , Chagas Disease/history , England , Family , History, 19th Century , ReligionABSTRACT
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Subject(s)
Microbiology/trends , Periodicals as Topic , PublishingABSTRACT
The history of science contains many cases of researchers who have died because of their professional activity. In the field of microbiology, some have died or have come close to death from infection by agents that were the subject of their research (Table 1). Infections that had a lethal outcome were usually accidental. Sometimes, however, researchers inoculated themselves with the pathogen or did not take preventive measures against the potential pathogen because they wanted to prove their hypotheses--or disprove someone else's--regarding the origin of the infection. Here is an overview of several episodes in the history of microbiology since the mid nineteenth century involving researchers or workers in fields related to microbiology who have become infected. They are considered here in their historical context to provide insights into some of the pillars of modern microbiology--The giants on whose shoulders several generations of microbiologists have stood to see further.
Subject(s)
Communicable Diseases/history , Microbiology/history , Occupational Exposure/history , Animals , Bacterial Infections/history , Bacterial Infections/microbiology , Communicable Diseases/microbiology , Communicable Diseases/virology , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Research , Virus Diseases/history , Virus Diseases/virologyABSTRACT
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Subject(s)
Animals , Humans , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Communicable Diseases/history , Microbiology/history , Occupational Exposure/history , Virus Diseases , Bacterial Infections , ResearchABSTRACT
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Subject(s)
Humans , Microbiology/trends , Periodicals as Topic/trendsABSTRACT
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