RESUMO
The role of surgery in the management of advanced carcinoma of the breast is controversial. Locally advanced carcinoma may present as a primary tumour or as recurrent disease. Treatment should be the result of a multi-disciplinary approach and may involve one or more different modalities. Minor surgery is usually meddlesome and often followed by local recurrence which is hard to control. Major resection does have a place, often in association with other modalities of treatment, and its use in carefully selected patients is described in this paper.
Assuntos
Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/cirurgia , Omento/cirurgia , Cirurgia Plástica/métodos , Feminino , Humanos , Mastectomia RadicalRESUMO
It has been observed that in human breast cancer transposition of the greater omentum to cover the excision site after removal of recurrent tumor appears to inhibit further recurrences at the site, without affecting spread to other sites. To establish an experimental model of this, inbred rats were transplanted in two sites on the chest with pieces of either an epithelioma or a mammary tumor. A flap of the omentum was then drawn through the peritoneal wall and then secured over one of the implants. In one group, this omentoplasty was carried out 1 week after tumor implantation. In most rats, the tumor in contact with the omentum was actually larger than the control, in contrast to the clinical observations. In many animals, the omentum was also a route of metastasis of the tumor.
Assuntos
Neoplasias Mamárias Experimentais/cirurgia , Omento/cirurgia , Animais , Modelos Animais de Doenças , Feminino , Métodos , Ratos , Ratos EndogâmicosRESUMO
In this series of 35 clinical cases, the versatility of the latissimus dorsal flap is demonstrated. Whilst its width is limited to approximately 10 cm to gain primary closure, its length extends from the axilla almost to the iliac crest. If a larger area of soft tissue cover is required, muscle only may be used covered with a split skin graft. Its safe rapid dissection, reliable blood supply and wide arc of rotation makes it suitable for many of the reconstructive needs in the trunk, head and neck. Its large vascular pedicle makes it particularly suitable for free flap transfer. The commonest indication for use of the flap has been reconstruction of the breast following radical surgery. The secondary morbidity at the donor site is negligible.
Assuntos
Mama/cirurgia , Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Neoplasias da Mama/cirurgia , Queimaduras/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Músculos/cirurgiaRESUMO
The greater omentum is readily available for the reconstruction of the defect produced after palliative excision of recurrent breast carcinoma. It covers a wide area and readily accepts a skin graft, and it has been observed that there is some local immunity to the reappearance of further recurrence at the site of the graft. The operation can be combined with endocrine ablation.
Assuntos
Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/cirurgia , Omento/transplante , Transplante de Pele , Cirurgia Plástica/métodos , Idoso , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Tempo , Transplante AutólogoRESUMO
Thirteen adults trekking in Nepal in 1974 to altitudes between 4,300 m and 5,500 m remained free from acute mountain sickness while taking spironolactone as a prophylactic measure. Two years previously five of these adults trekking at similar altitudes, but without treatment, had suffered from acute mountain sickness. The regime used was spironolactone in a dosage of 25 mg three times a day for two days preceding and during the periods spent at altitudes above 3,000 m.