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PubMed2004

[Symptom distresses and coping strategies in breast cancer women with mastectomy].

The purpose of this descriptive cross-sectional survey was to understand the correlation between symptom distresses and coping strategies in female victims of breast cancer with in two years of their undergoing a mastectomy. The instruments used in this study were the Physical Symptoms Scale, short form of Profile of Mood states (POMS-SF), Social Function Distress Questionnaire, Jalowiec Coping scale (JCS), and demographic data. The data were analyzed by descriptive statistic, t-test, one-way ANOVA, post Scheffe test and Pearson product-moment correlation. The essential results are summarized as follows. Degrees of biopsychosocial distresses varied from none to mild. Physical symptom distress, psychological distress, and social function distress were positively correlated. When patients were confronted with symptom distresses, they tended to adopt problem-focused coping strategies. The more problem-focused coping strategies, they used the less symptom distresses they experienced. The results of this study could be used to help to develop nursing interventions and efficient coping strategies. Patient may then be able to use the latter to solve symptom distresses and enhance their quality of life.

Adaptation, Psychological↗
PubMedDate not supplied

[Analgesic alternatives for the control of postoperatory pain in radical mastectomy].

INTRODUCTION: The purpose of preventive analgesia based on regional blocks with local anesthetics is to avoid sharp and hard-to-control pain in the anterior side of thorax and axilla secondary to radical mastectomy. OBJECTIVE: Our aim was to compare the analgesic effectiveness of direct trans-operational block applied to nerves vs conventional analgesia using analgesic-antipiretic and antiinflammatory (AINES) drugs. MATERIAL AND METHODS: We designed a 1-year case-control study at the Hospital de Oncología of the Instituto Mexicano del Seguro Social's (IMSS's) Centro Medico Nacional Siglo XXI (CMN-SXXI) in Mexico City. A total of 112 patients were mastectomized under general anesthesia: Thirty one patients received preventive analgesia (cases) by direct transoperational infiltration of brachial and intercostal nerves III-VI; bupivacaine 1 mg/kg and buprenorphine 0.005 mg/kg in 15 ml were distributed among appropriate nerves accompanied by a single dose of AINES in emersion stage; during anesthetic emersion, 81 patients received conventional analgesia (control), including endovenous AINES alone or combined, and buprenorphine 0.3 mg or nalbuphine 10 mg. Three evaluations employing analog visual scale were conducted: recovery (immediate post surgery); floor (mediate), and following day. RESULTS: We studied 110 women and two men. Demographic, laboratory, anesthetic, and surgical variables were similar in both groups (p = not significant [ns]). In no case was post-surgical pain reported. Among controls, slight pain was reported by 13 patients, moderate pain by 66, and severe pain was reported by two patients, whereas in patients returned to their rooms on the floor, slight pain was reported by 38, moderate by 42, and severe by one. Finally, on the following day all patients reported slight pain. Types of pain included 15 patients with somatic pain, 10 with neuropathic, and 56 patients with mixed pain (p <0.0001). CONCLUSIONS: Preventive analgesia by direct transoperational block on nerves turned out to be an effective alternative with low level of systemic morbidity, which must be considered to prevent moderate and severe pain syndromes that are difficult to control in thoracic oncological surgery.

Analgesia↗
PubMed1992

Breast preservation versus mastectomy in early breast cancer--1991 update of the GBSG 1--protocol and prognostic factors. The German Breast Cancer Study Group.

In 1983, the German Breast Cancer Study Group (GBSG), sponsored by the Federal Ministry of Research and Technology, started a prospective multicenter trial on the treatment of early breast cancer (pT1 pN0 M0). This was preceded by a three-year reviewing period because of some novelties of medical, juristical and ethical problems in the FRG. University and, in the majority, community hospitals participated, combining all together 69 different institutions. From 11/1983 to 12/1989, 1112 patients were recruited. From 1036 patients, 733 underwent breast preservation (71%) and 303 mastectomy (29%). The randomization rate was only 6%. In 268 patients (26%) the tumor size was less than or equal to 10 mm, in 765 patients (74%) 11 to 22 mm. In 129 cases, we subdivided the tumor grading II[3] into IIa and IIb. Moreover, the immunohistochemical detection of the transmembrane proteins EGFR, p-185 and p-148 by oncogene overexpression and c-myc oncogene were undertaken in 425 breast cancers. After tumorectomy (or wide excision) and a lower axillary dissection (at least eight lymph nodes) the breast was irradiated up to 50 Gy in 25 fractions. A boost of 12 Gy was given to the tumor bed. The medial located lymph nodes were also irradiated in case of medially or centrally tumors. Quality control was performed by pathological, radiotherapeutic and methodical reference centers. Significant correlations could be demonstrated between receptor status and tumor grading, patient age and grading, and tumor size and grading. The results emphasize the central role of tumor grading among the prognostic factors. Especially the differentiation of the Bloom and Richardson score II into IIa and IIb seems to play an important role. After a median follow-up of 41 months, the frequency of local recurrences (4.4%), regional recurrences (1%) and distant metastases (4.6%) was exactly the same in both treatment groups. In multivariate analysis, only tumor size and tumor grading had a significant impact on disease-free survival. 23 patients with tumor-involved margins had a higher recurrence rate (DFS 62% versus 85% after five years). Without any impact on DFS were the other conventionally evaluated prognostic factors: age, menopausal status, hormone receptor status, histological tumor type, tumor localisation, degree of differentiation, pleomorphism, mitotic index and degree of dissociation. Among the transmembrane proteins EGFR, p-185, p-148 and c-myc, only the impact of p-185 and EGRF positivity on DSF is significant.(ABSTRACT TRUNCATED AT 400 WORDS)

Breast↗
PubMed1992

[Partial mastectomy in the treatment of breast cancer].

In the submitted paper the authors summarize findings on conservative surgery in the treatment of breast cancer. Based on data in the literature and their own experience with surgical treatment of breast cancer of all stages and a detailed analysis of a group of 52 conservatively treated patients, the authors discuss indications for this treatment which must respect staging, typing and grading of tumours as well as attitudes of patients. In particular in tumours classified as T1, NO, MO (as well as T2, NO, MO up to 3 cm) with a non-central localization it is possible by using conservative surgery to avoid somatic mutilation and psychic sequelae of radical procedures. When an individual approach is used and the correct indication is selected, partial mastectomy with dissection of the axilla and postoperative radiotherapy is equivalent to therapeutic results of radical operation.

Adult↗
PubMed1992

[A surgical technique for partial mastectomy].

The authors are describing the technique of the partial mastectomy for the breast cancer in this work, as used in the Masaryk oncological institute. For easy understanding they are adding illustrations of the singular phases of this operation. They are also discussing the indications and are showing a short historical review of the authors having published the results of this surgery.

Female↗
PubMedDate not supplied

[Manual lymph drainage of post-mastectomy "big arm"].

We estimate the effectiveness of the manual lymphodrainage in the patients with post-mastectomy lymphedema of the upper limb associated to axillary lymphnodes dissection of the ipsilateral arm. The best results were found in the patients with soft and recent lymphedema (which means that was seen within one year); the worst were found in the chronic hard lymphedema. An important psychological assistance and physiotherapy were required to complete the rehabilitation. However, the physiotherapy was very effective when associated to pressed bandage of the arm, at the end of the LDM therapy. Furthermore, the muscle contraction in the bandage had reinforced the lymphoematic pump effect.

Adult↗
PubMedDate not supplied

[Reduction of lymphatic drainage posterior to modified radical mastectomy with the application of fibrin glue].

OBJECTIVE: Our objective was to investigate the effectiveness of fibrin glue to reduce hemato-lymphatic fluid production after modified radical mastectomy (MRM) in women with breast cancer. MATERIAL AND METHODS: A total of 43 women treated surgically were randomly assigned to receive 10 ml of fibrin glue at the end of the breast resection plus closed suction drains (n = 22), or drain system only as a control group (n = 23). Outcome variables were fluid collected in the drainage system measured each 24 h. Drains were removed when a 50 ml output per day was obtained. Seroma formation and flap complications were also investigated. RESULTS: The average age was 48.36 +/- 8.9 years for the study group and 52.87 +/- 9.74 years for the control group (p = 0.11). Body mass index (BMI) ranged between 22 and 35 kg/m2: 28.1 +/- 2.7 vs. 29.92 +/- 4.0 kg/m2 (p = 0.27). A reduction of the fluid drained was observed from the first postoperative day in the study group in contrast with the control (174.55 +/- 64.69 vs. 281.22 +/- 116.91, p = 0.001). A correlation between the BMI and the exposed surgical area was also statistically significant (p < 0.002), as well as the day the drains were extracted (p < 0.05). The incidence of seroma formation was 9% in the study group and 34.78% in the control, a statistically significant finding (p < 0.05). CONCLUSIONS: Fibrin glue locally applied to the surgical wound under the flap and axilla significantly reduced the amount and duration of lymphatic fluid produced after MRM with axillary dissection. Also, a significant reduction in the incidence of seromas was observed.

Breast Neoplasms↗
PubMed2005

The left sternalis muscle variation detected during mastectomy.

The sternalis muscle variation is a well-known anatomical situation. It is present in 8.7% of women and 6.4% of men, although the incidence varies according to sex, race and ethnicity. During a left modified radical mastectomy operation on a 46-year-old female patient a sternalis muscle was detected on the pectoralis major muscle in the superficial fascia. It was in craniocaudal position and was parallel to the body of the sternum. The cylindrical muscle was approximately 8 cm in length and 2 cm in diameter. Such variations are considered to have their origin in embryological development. Awareness of muscular variations and their identification is important both for procedure through the proper dissection planes during breast surgery and in radiological examination and follow-up.

Breast Neoplasms↗
PubMed2006

[Anesthetic management of concomitant off-pump coronary artery bypass grafting, pulmonary resection, and mastectomy].

Recently, an increasing number of patients with both ischemic heart disease and malignancy have underwent cardiac surgery and other operations simultaneously, as indication of off-pump coronary artery bypass grafting (OPCAB) has been expanded. A 66-year-old woman underwent OPCAB and other two operations for malignant diseases. General anesthesia was maintained by total intravenous infusion of propofol and fentanyl, and the patient's hemodynamics were kept stable throughout the operation under continuous administration of cardiotonics: dopamine, norepinephrine, and milrinone. The procedure for the operations was discussed in a conference with surgeons: 1. OPCAB 2. right middle and lower lobectomy and 3. right mastectomy. There were no postoperative complications.

Aged↗
PubMedDate not supplied

Influence of drape permeability on wound contamination during mastectomy.

Sixty-one patients undergoing mastectomy at three hospitals were randomly allocated to receive one of three types of drape: permeable linen sealed to the skin with self-adhesive nonwoven tape, and impermeable nonwoven with self-adhesive edges. Bacteriological contamination was assessed both in the wound and in the wound surroundings. The air counts at the centres differed but were generally low, mean approximately 10(1) colony-forming units (CFU)/m3 but higher at the beginning of the operation. Patients whose skin counts were high before disinfection had the highest skin counts after disinfection and operation and gave the highest counts on the gloves of the surgeon. The use of impermeable drapes instead of permeable linen drapes resulted in significantly fewer bacteria in the operative field (393 CFU/50 cm2 compared with 664, p less than 0.002) and also in the wound itself (12 compared with 164 CFU/sample, p less than 0.01). As a result of correlations between counts, we are also able to show how bacteria transfer from the patient's skin to the surgical wound.

Air Microbiology↗
PubMed1990

[Prepubertal gigantomastia treated by mastectomy with an implant].

The authors present an exceptional case of mammary giantism with marked ptosis covering the entire abdomen of an 11-year-old girl; this diffuse virginal hypertrophy, occurring in children or adolescents, results from a hypersensitivity of mammary tissue to a normal level of estrogen. Relapses from residual tissue following a mammaplasty reduction have led certain authors to propose immediate sub-cutaneous mastectomy and reconstitution by prothesis.

Breast↗
PubMedDate not supplied

[Secondary breast bilateral reconstruction with myocutaneous pedicled latissimus dorsi flap after primary bilateral skin sparing mastectomy reconstruction with consecutive severe capsular contraction].

We present a patient who was operated due to bilateral breast carcinoma with immediate bilateral breast reconstruction with silicone implants after skin sparing mastectomy in a neighbouring country to Croatia. One year following the operation a severe bilateral capsular contracture was manifested. Due to a large umbilical hernia and lower laparotomy scar it was not possible to reconstruct the breasts with any abdominal free or pedicled flap. We performed bilateral secondary breast reconstruction with latissimus dorsi myocutaneous flap and silicone implants in two stages with good postoperative result.

Adult↗
PubMed2005

TRAM flap for immediate post mastectomy reconstruction: comparison between pedicled and free transfer.

UNLABELLED: Breast reconstruction after mastectomy is primarily carried out to improve the patients' quality of life. The most commonly used autologous tissue for reconstruction is the transverse rectus abdominis musculocutaneous flap (TRAM). The TRAM flap could be transferred either as pedicled or a free flap with microvascular anastomosis. The following work was carried out to evaluate the two techniques. PATIENTS AND METHODS: Thirty-one female patients with operable breast cancer consented to immediate breast reconstruction during the period from June 1998 to December 2000. Fifteen patients had a free TRAM flap reconstruction. In sixteen patients, a pedicled TRAM flap was used. Three patients in the pedicled group underwent bilateral breast reconstruction, thus there were 19 pedicled flaps available for evaluation. Four patients in the pedicled flap group underwent reduction mammoplasty of the normal breast and in five other patients a bipedicled flap was used to achieve size matching with the reconstructed breast. Criteria for analysis included operative data, hospital stay, donor site morbidity, abdominal wall integrity, flap related complications, fat necrosis and final aesthetic result. RESULTS: There was no difference between the two groups as regards age and, operative time. The pedicled flap group had shorter hospital stay and less blood loss than the free flap group, which was statistically significant (p=0.007 and p=0.001, respectively). In the pedicled flap group, two patients (10.5%) experienced partial flap loss and fat necrosis was detected in two other patients. For the free flap group, two patients (13.3%) developed complete flap loss, but none suffered fat necrosis. Donor site morbidity was equal in both groups. The total number of complications was higher in the pedicled group (7/19) (36.8.8%) than in the free flap group (5/15) (33.3 degrees k) but this was not statistically significant (p=0.27). None of the patients in both groups developed abdominal wall hernia, but abdominal wall weakness was evident in eight patients in the pedicled flap group that gradually improved over 2-3 months. Aesthetic results were comparable in both groups with a slightly better figure for the free flap group, but this was not statistically significant (p=0.23). IN CONCLUSION: Although free TRAM flap seems to provide several advantages over the pedicled group, namely skin volume available for harvesting, preservation of abdominal wall integrity, and better flap contouring, yet the pedicled TRAM flap is a reliable and easy technique that will produce matching aesthetic results.

Adult↗
PubMedDate not supplied

A giant papillary carcinoma of the breast treated with mastectomy and bipedicled TRAM flap.

Although the surgical treatment of breast cancer has become more conservative in the last decades, some patients still arrive at the first physical examination with advanced diseases and with large skin infiltration. We report an unusual case of giant invasive papillary carcinoma of the breast underwent mastectomy and reconstruction with a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap.

Aged↗
PubMed2006

[Breast carcinoma and anaplastic gastric carcinoma with pleural metastases in patient after mastectomy 30 years ago].

We describe a case of two simultaneous malignancies--anaplastic gastric carcinoma with pleural metastases and left breast carcinoma. These malignancies were recognized in 78-year old woman after right mastectomy performed 30 years ago. Additionaly, during diagnostic procedures rectal polypus found during colonoscopy occurred to be adenoma tubulovillosum. Her parents died from malignancies--mother from gastric cancer and father from pulmonary carcinoma. One should remember that there is always possibility of simultaneous development of more than one primary malignancies in one patient and neoplastic disease is an important cancer risk factor. This observation confirms the important role of genetic factors in the pathogenesis of malignant diseases.

Aged↗
PubMed1991

Bilateral breast reconstruction after mastectomy.

The authors discuss the development of breast reconstruction following mastectomy in Czechoslovakia and present their first case of bilateral reconstruction employing the technique of the TRAM flap. In addition, they explore the possibility of eliminating high-risk parenchyma during with contralateral reconstruction.

Abdominal Muscles↗