Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flaw progression in patients with breast cancer undergoing axillary dissection This was a randomized experimental study oil 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups without physiotherapeutic stimulation (WOPS, n=10) and with physiotherapeutic stimulation (WPS, n=12) The lymphoscintigraphy scan was performed with (99m)Tc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases dynamic, static, and delayed whole body imaging Physiotherapeutic stimulation was earned out using Foldi's technique In both groups, images from the two examinations of each patient were compared Flow progression was considered positive when, on the second damnation, the radiopharmaceutical reached areas more distant from the injection site Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted Descriptive analysis showed that the WPS and WOPS groups were similar M terms of mean age, weight, height, body mass index and number of lymph nodes removed There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p < 0 0001) Early physiotherapeutic stimulation in beast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema

Morfoanatomia e histoquímica de órgãos reprodutivos de Brosimum gaudichaudii (Moraceae)

Brosimum gaudichaudii Trécul, popularmente conhecida como mama-cadela, é uma espécie arbórea comum nos cerrados brasileiros, de grande importância na alimentação e na medicina popular. A polpa amarela dos frutos é muito apreciada pelas crianças por ser semelhante à goma de mascar. Neste trabalho é apresentada a caracterização morfoanatômica e histoquímica da inflorescência, fruto e semente de B. gaudichaudii. O material foi processado segundo técnicas usuais para estudos anatômicos e ultra-estruturais. As inflorescências são captadas, globosas, pedunculadas, pendentes, predominantemente aos pares nas axilas foliares e recobertas por brácteas peltadas densamente pilosas. Cada inflorescência é composta por várias flores masculinas e uma flor feminina. As flores masculinas são constituídas por um estame envolvido por bractéolas. A flor feminina é constituída por um pistilo com ovário ínfero penta-carpelar, entretanto um só lóculo se desenvolve. É comum a presença de dois óvulos no lóculo desenvolvido; entretanto somente um óvulo se desenvolve em semente. O óvulo é pêndulo, hemianátropo e bitegumentado apenas na região micropilar. No fruto maduro, identificam-se: a polpa, correspondente a parte comestível, e endocarpo; na semente, o tegumento é membranáceo e o embrião não apresenta endosperma secundário. O tecido parenquimático da polpa apresenta muitos espaços intercelulares, repletos de conteúdo aquoso. O endocarpo é esclerificado e encontra-se bem diferenciado no fruto maduro. Os laticíferos são do tipo não-articulado ramificado, com paredes espessas e ocorrem no receptáculo da inflorescência, são abundantes no pedúnculo e na polpa do fruto maduro e no embrião. Os idioblastos fenólicos estão distribuídos na inflorescência e no fruto.

Subcutaneous and testicular metastasis from prostatic adenocarcinoma with neuroendocrine differentiation

The pathological finding of testicular metastasis in cases of disseminated prostatic adenocarcinoma is rare, but was more frequently reported in the past, when bilateral castration was performed more often. The existence of skin and subcutaneous metastasis adds a worse prognosis, because generally it is sign of advanced disease with an average survival time of less than one year. The synchronous occurrence of such metastasis has not been described previously, neither their association to neuroendocrine differentiation. The presence of such differentiation of prostatic adenocarcinoma represents a very unfavorable prognostic factor, as suggested in recent literature. Herein, we discuss the case of a 53 year old man, who presented with macroscopic hematuria and frequency associated to several painless subcutaneous nodules in left axilla and shoulder, as well as in the lower abdominal wall. The right testis was painful, endured and on rectal examination, the prostate was diffusely enlarged. Serum PSA was elevated, reaching 1760 ng/ml and prostatic biopsy disclosed a Gleason 10 prostatic adenocarcinoma with neuroendocrine differentiation. The same pathological pattern was detected in the right testis and in all subcutaneous nodules, documented by positive staining of chromogranin, a marker of neuroendocrine cells. He was submitted to a prostate tunnelization and maximal androgen blockade plus adjuvant chemotherapy, nevertheless, he died 5 months latter.

Otimização da circulação linfática em pacientes pós-linfadenectomia radical axilar recente por meio da estimulação linfonodal avaliada pela linfocintilografia

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Diagnóstico diferencial entre Doença de Crohn e Hidradenite Supurativa: relato de caso

Crohn’s disease is a chronic infl ammatory bowel disease with segmental transmural infl ammation, which complicate with formation of fi stulas and abscesses. The hidradenitis suppurativa (HS) is characterized by recurrent abscesses, with a predilection for areas rich in apocrine glands such as the axillary, inguinal and perineal. The differential diagnosis between these diseases is diffi cult and may compromise treatment. Report case: C.R.M.A., 40 year-old, female, white, ileal and colonic Crohn’s disease complicated with perianal and rectovaginal fi stula for 12 years, treated with biological therapy since May 2010. In Sep/2010 presented with an abscess in the buttock D with purulent discharge refractory to the use of ciprofl oxacin and metronidazole. USG: collection of 30 cm3 in buttock D. The diagnosis was HS and the patient underwent extensive surgical removal of the affected areas (10 x 2 cm) with healing by secondary intention. Skin graft performed unsuccessfully in Dec/2010. The patient returned in jan/2011 with a new fi stula at the site of resection, consistent with Crohn’s disease. In fev/2011 underwent drainage of abscesses and placement of setons in perianal fi stulas. Currently in therapy with good biological evolution of fi stulas. The prevalence of HS varies from 0.3 to 4% of the population in general. The axilla is the region most affected and perianal lesions are associated with greater weakness. There are published reports of association between HS and Crohn’s disease sporadically and further studies are needed to assess a common pathogenesis. The differential diagnosis should be performed in all cases planning immediate treatment, avoiding complications and worsening of the patient’s quality of life.