Effectiveness of 5-Fluorouracil and Hypertonic Glucose in the Prevention of Post-mastectomy Seroma in an Experimental Animal Model.

INTRODUCTION: Seroma is a frequent complication that can affect the final result of reconstructive and cosmetic surgeries. METHODOLOGY: This study evaluated the effectiveness of 5-Fluorouracil and 75% hypertonic glucose in preventing seroma in a mastectomy rat model, as well as cellular and vascular events in adjacent tissues. A left mastectomy with lymphadenectomy was performed in 60 Wistar-Albino female rats. Animals randomly allocated to the control group (Group I; n = 20) were sutured right after mastectomy. The intervention groups received 1.0 mL of 75% hypertonic glucose (Group II; n = 20) or 1.0 mL of 5-Fluorouracil (Group III; n = 20) at the surgical site before suturing. The assessment of the presence of seroma was performed in all animals at 24, 48, and 72 h and on the 7th and 12th postoperative day. After the 12th day, a tissue sample was taken from the surgical site and sent for histological analysis. The occurrence of seroma was assessed using GEE. A significance level of 5% was adopted. RESULTS: Differences in seroma formation over time were observed for both Control Group I (p=0.041) and Intervention Group II (p<0.001). In Intervention Group III, there was no difference in the percentage and volume of seroma across the assessment points (p=0.627). When both the Control and Intervention Group II were compared to Intervention Group III, we found a reduction in seroma formation in the last group. The reduction in the inflammatory process was more regular to Intervention Group III. CONCLUSION: In this animal model, 5-Fluorouracil was more effective in preventing seroma formation than 75% Hypertonic Glucose. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Somatic mutations in early onset luminal breast cancer.

Breast cancer arising in very young patients may be biologically distinct; however, these tumors have been less well studied. We characterized a group of very young patients (≤ 35 years) for BRCA germline mutation and for somatic mutations in luminal (HER2 negative) breast cancer. Thirteen of 79 unselected very young patients were BRCA1/2 germline mutation carriers. Of the non-BRCA tumors, eight with luminal subtype (HER2 negative) were submitted for whole exome sequencing and integrated with 29 luminal samples from the COSMIC database or previous literature for analysis. We identified C to T single nucleotide variants (SNVs) as the most common base-change. A median of six candidate driver genes was mutated by SNVs in each sample and the most frequently mutated genes were PIK3CA, GATA3, TP53 and MAP2K4. Potential cancer drivers affected in the present non-BRCA tumors include GRHL2, PIK3AP1, CACNA1E, SEMA6D, SMURF2, RSBN1 and MTHFD2. Sixteen out of 37 luminal tumors (43%) harbored SNVs in DNA repair genes, such as ATR, BAP1, ERCC6, FANCD2, FANCL, MLH1, MUTYH, PALB2, POLD1, POLE, RAD9A, RAD51 and TP53, and 54% presented pathogenic mutations (frameshift or nonsense) in at least one gene involved in gene transcription. The differential biology of luminal early-age onset breast cancer needs a deeper genomic investigation.

Calcitriol supplementation effects on Ki67 expression and transcriptional profile of breast cancer specimens from post-menopausal patients.

BACKGROUND & AIMS: High concentration of 1,25(OH)2D3 (50-100 nM), which cause hypercalcemia in vivo, induce the hormone transcriptional targets and exert antiproliferative effects in cultured breast cancer lineages, however, no studies investigated whether these effects might be reproduced in tumor specimens in vivo. Our aim was to evaluate the effects of calcitriol supplementation on the proliferative index (Ki67 expression) and gene expression profile of post-menopausal breast cancer samples. METHODS & RESULTS: Tumor samples were collected from 33 patients, most of whom (87.5%) presenting 25(OH)D3 insufficiency, before and after a short term calcitriol supplementation (0.50 µg/day PO, for 30 days). Tumor dimension remained stable in ultrasound evaluations. A slight reduction in Ki67 immunoexpression was detected, however in only 10/32 post-calcitriol samples an expressively low proliferative index [Ln (%Ki67+) < 1] was achieved. Gene expression from 15 matched pre/post-supplementation samples was analyzed by microarray (U133 Plus 2.0 GeneChip, Affymetrix) and 15 genes were over-expressed in post-supplementation tumors, including FOS and EGR1, which were previously shown to be regulated by vitamin D. However, these results were not confirmed in another four breast cancer samples. CONCLUSIONS: Calcitriol supplementation is neither sufficient to expressively elicit an antiproliferative response nor to induce the hormone transcriptional signaling pathway in breast cancer specimens.

Granuloma Piogênico: descrição de dois casos incomuns e revisão da literatura / Pyogenic granuloma: description of two unusual cases and review of the literature

Granuloma piogênico é proliferação vascular benigna e comum, geralmente secundária a eventos como trauma cutâneo. É sabido que algumas lesões podem mimetizar o melanoma e vice-versa, sendo recomendadas remoção cirúrgica e análise anatomopatológica. O advento de tecnologias que ampliam a imagem reconhecida pelo olho, como a dermatoscopia, através da identificação de algumas estruturas e determinação de padrões específicos, pode facilitar essa diferenciação e ajudar na tomada de decisões. Em situações raras, sua apresentação clínica mostra-se inusitada, e o objetivo deste artigo é demonstrar esse fato e revisar a literatura médica sobre o assunto, com foco nos achados dermatoscópicos.

Pyogenic granuloma is a common, benign, vascular proliferation, usually secondary to other events, such as cutaneous trauma. It is known that some lesions can mimic melanoma and vice versa, and it is recommended that the lesion be surgically removed and analyzed histologically. The advent of technologies-such as dermoscopy-that amplify the image recognized by the eye through the identification of certain structures and specific patterns, can facilitate this differentiation and assist in decision-making. In rare situations, its clinical presentation is unusual. The current article is aimed at demonstrating this fact and reviewing the medical literature on the subject, focusing on dermoscopic findings.

Avaliação da distância entre a origem do tronco celíaco e da artéria mesentérica superior (nota prévia) / Distance evaluation between the origin of the celiac trunk and from the superior mesenteric artery (advance notice)

Os autores, em decorrência das controvérsias existentes na literatura e tendo em vista a necessidade de parâmetros confiáveis, os quais são cada vez mais solicitados, avaliaram a distância entre o tronco celíaco e a artéria mesentérica superior, pela face interna da artéria aorta abdominal em 25 casos.

As result of the controverses that exists in the literature andconsidering the necessity for reliable standards, which are moreand more demanded, the authors measured the distance betweenthe celiac trunk and the superior mesenteric artery, through theinternal side of the abdominal aorta in 25 cases.

Reconstrução de coroa e recontorno cosmético com resina composta direta em dentes anteriores: relato de caso / Crown reconstruction and cosmetic recontour with direct composite resin in anterior teeth: case report

Os avanços relativos às resinas compostas e às técnicas adesivas à estrutura dental têm possibilitado ampliar as opções de tratamento. O objetivo deste trabalho é revisar e discutir essas opções e relatar um caso clínico em que se executou uma reconstituição total de um incisivo central superior com resina composta direta e recontorno dos incisivos e caninos superiores, a fim de reabilitar estética e funcionalmente a dentição