Cáncer de mama en varones: casos recogidos en 20 años (1990-2011) / Breast cancer in males and cases observed in 20 years (1990-2011)

Introducción: en la sociedad occidental el cáncer de mama es el de mayor prevalencia en el sexo femenino, pero es muy raro en el sexo masculino (0,1-0,2 por ciento). Tras analizar la epidemiología y los factores de riesgo, se realizó un estudio retrospectivo de los casos hallados en una unidad de unidad de cirugía menor ambulatoria (CmA) del Hospital General de Especialidades Juan Grande en el periodo de 1990 a 2011 (n = 10). Métodos: se describen los hallazgos en la unidad CmA, adonde acuden pacientes con diagnósticos de afecciones benignas, fundamentalmente de piel, anejos cutáneos y tejidos subcutáneos. Se eligió, describió y siguió a los varones que resultaron tener un carcinoma de mama. Los criterios de inclusión fueron el sexo masculino y la confirmación histológica de cáncer de mama. Se estudiaron las variables epidemiológicas, tumorales y terapéuticas, y la supervivencia. Resultados: hubo 10 sujetos con edades de 58 ± 15 años, sin antecedentes de especial interés. Las tumoraciones se localizaban en la cara anterior del tórax, en la región mamaria, de forma unilateral. El 100 por ciento de los pacientes acudieron con diagnóstico de una afección benigna, e igualmente en el 100 por ciento de los casos el diagnóstico anatomopatológico definitivo fue carcinoma ductal. Conclusiones: los pacientes se diagnosticaron después de una cirugía y no hubo diagnóstico clínico previo. La supervivencia estuvo condicionada por la tardanza en el diagnóstico y, por tanto, en el inicio del tratamiento. La supervivencia a los 5 años de revisiones fue de 7 pacientes, aunque algunos fallecieron por otras causas(AU)

Introduction: breast cancer in the Western society has the highest prevalence rate in females, but it is very rare in males (0.1-0.2 percent). After analyzing the epidemiology and the risk factors, a retrospective study was conducted on the cases found in an outpatient minor surgery unit of Juan Grande general hospital of medical specialties in the period of 1990 through 2011 (n= 10). Methods: the findings observed in this unit were described, where patients with benign disease diagnoses fundamentally went because of skin problems, cutaneous adnexes and subcutaneous tissues. The males suffering breast carcinoma were selected, described and followed-up. Inclusion criteria were being male and histological confirmation of breast cancer. The epidemiological, tumoral and therapeutical variables were under study as well as survival rates. Results: there were 10 individuals aged 58 ± 15 years, with no history of special interest. Tumors were located in the anterior side of thorax, unilateral, in the breast region. One hundred percent of patients went to the unit with benign diagnosis and, the final anatomopathological diagnosis of all the cases was ductal carcinoma. Conclusions: the patients were diagnosed after one surgery and there was not previous clinical diagnosis. The survival depended on the time of diagnosis and on the time of beginning the treatment. The survival rate after 5 years of review was 7 patients, although some died from other causes(AU)

Differences in polypropylene shrinkage depending on mesh position in an experimental study.

BACKGROUND: Polypropylene (PP) mesh is one of the most frequent materials used in hernia repair. We have experimentally evaluated the shrinkage of PP mesh depending on the place of implantation. METHODS: In 15 New Zealand rabbits a muscular defect measuring 3 x 3 cm was created in both pararectal sides of the abdominal wall. The defect was repaired using a PP mesh measuring 5 x 3.5 cm that was placed in the right side in the sublay location and in the left side in the onlay location. Five animals were killed on the 30th, 60th, and 90th postoperative days. Macroscopic measurement and microscopic study of the prosthesis-host tissue interfaces were performed. RESULTS: One rabbit was killed because of severe infection in the onlay mesh. Another 2 infections were tolerated in the onlay mesh side. All the prostheses were integrated in the host tissue at death. In the macroscopic evaluation the mesh areas were reduced by 25.92% on the 30th day, by 28.67% on the 60th day, and by 29.02% on the 90th day. The mesh shrinkage was greater in the onlay group than in the sublay group at the 3 time intervals. More inflammatory leukocyte and mononuclear responses also were seen in the onlay group. CONCLUSIONS: These observations support the theory of PP mesh shrinkage as a consequence of the incorporation of the biomaterial to the scarring tissue. This shrinkage is significantly more intense if the meshes are placed in the onlay position.

Seguimiento de la contracción de las mallas de polipropileno empleadas en la reparación de eventraciones / Surveillance of shrinkage of polypropylene mesh used in the repair of ventral hernias

Introducción. El polipropileno (PP) es uno de los biomateriales más empleados en la reparación quirúrgica de las eventraciones. Aunque se conoce bien su capacidad de integración tisular en el huésped, se discute si las mallas sufren un proceso de contracción que reduce su tamaño durante el mecanismo de incorporación al proceso de cicatrización del huésped. Objetivo. Cuantificar el proceso de contracción de las mallas de polipropileno. Pacientes y método. Se ha diseñado un estudio de seguimiento radiológico en 23 pacientes consecutivos operados de eventraciones de la línea media con un diámetro mínimo de 5 cm. Las mallas de polipropileno fueron marcadas con clips de titanio en sus ejes mayores transversal y longitudinal. Se realizaron radiografías seriadas el primer día del postoperatorio, al mes, y a los 3, 6 y 12 meses. Se midieron las distancias entre los clips y se calculó el área de la malla. Resultados. Se operó a 17 mujeres y 6 varones. En 9 pacientes la malla se colocó en el espacio supraponeurótico y en 14 en el espacio subaponeurótico. Se produjeron 4 seromas en los pacientes tratados con malla en situación supraponeurótica. La reducción del área calculada ha sido del 12% al mes, 24% a los 3 meses, 29% a los 6 meses y 34% a los 12 meses. Conclusiones. Las mallas de PP han ofrecido excelentes resultados clínicos. En el seguimiento radiológico se ha comprobado una contracción considerable de la malla, fundamentalmente, durante los primeros 3 meses tras el implante (AU)

Introduction. Polypropylene (PP) mesh is one of the most frequently used materials in the surgical repair of ventral hernias. Despite the widely recognized ability of PP to integrate into the host tissue, these meshes may shrink during the healing process in the patient. Objective. To quantify polypropylene mesh shrinkage. Patients and method. A radiological follow-up study was performed in 23 consecutive patients who underwent surgery for midline ventral hernias with diameters of at least 5 cm. PP meshes were marked with titanium clips at the ends of their longest transverse and longitudinal axes. X-rays were performed on the first postoperative day and at 1, 3, 6 and 12 months. The distances between clips were measured and the area of the mesh was calculated. Results. Seventeen women and six men underwent surgery. In nine patients the mesh was placed on the prefascial space (onlay) and in 14 in the subfascial space (sublay). There were four seromas in patients with mesh placed with the onlay technique. The reduction in the calculated area was 12% at 1 month, 24% at 3 months, 29% at 6 months and 34% at 12 months. Conclusions. PP mesh provided excellent clinical results. Radiological surveillance revealed substantial shrinkage, mainly in the first 3 months after implantation (AU)

[Surveillance of shrinkage of polypropylene mesh used in the repair of ventral hernias]. / Seguimiento de la contracción de las mallas de polipropileno empleadas en la reparación de eventraciones.

INTRODUCTION: Polypropylene (PP) mesh is one of the most frequently used materials in the surgical repair of ventral hernias. Despite the widely recognized ability of PP to integrate into the host tissue, these meshes may shrink during the healing process in the patient. OBJECTIVE: To quantify polypropylene mesh shrinkage. PATIENTS AND METHOD: A radiological follow-up study was performed in 23 consecutive patients who underwent surgery for midline ventral hernias with diameters of at least 5 cm. PP meshes were marked with titanium clips at the ends of their longest transverse and longitudinal axes. X-rays were performed on the first postoperative day and at 1, 3, 6 and 12 months. The distances between clips were measured and the area of the mesh was calculated. RESULTS: Seventeen women and six men underwent surgery. In nine patients the mesh was placed on the prefascial space (onlay) and in 14 in the subfascial space (sublay). There were four seromas in patients with mesh placed with the onlay technique. The reduction in the calculated area was 12% at 1 month, 24% at 3 months, 29% at 6 months and 34% at 12 months. CONCLUSIONS: PP mesh provided excellent clinical results. Radiological surveillance revealed substantial shrinkage, mainly in the first 3 months after implantation.

Prevalence and management of hernias in peritoneal dialysis patients.

OBJECTIVES: The aim of this study was to assess the prevalence of hernias before and after the start of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal disease, and to evaluate the result of a proposed surgical treatment. DESIGN: Prospective observational study. SETTING: University hospital. PATIENTS: 122 patients who started CAPD from 1994 to 2000; 26 hernias were diagnosed in 21 (17.2%) patients. MAIN OUTCOME MEASURES: Finding of hernias; morbidity associated with catheter insertion and hernia repair; recurrence of hernias. RESULTS: 19 hernias were detected in 15 patients (12.3%) before they began CAPD; only 7 hernias were observed while on CAPD. Umbilical (61.5%) and inguinal (26.9%) hernias were the most common. Multiple hernias were detected in 4 patients. Simultaneous repair of hernia and catheter insertion was performed in patients with pre-existing hernias. Under local anesthesia, most patients were operated on with surgical techniques of tension-free hernioplasty using a polypropylene mesh. Only mild post-operative complications were recorded: 3 seromas and 1 hematoma. No fluid leakage was found in our series. There were no long-term complications (infection or recurrence) related to the mesh. CONCLUSIONS: 73% of hernias in peritoneal dialysis patients occur before starting dialysis. Hernia problems in these high-risk patients can be safely solved using a careful technique with application of tension-free hernioplasty. Most may be repaired under local anesthesia with simultaneous catheter insertion.