990 resultados para Breast conserving surgery
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A maximização do potencial da abordagem cirúrgica conservadora da axila para o cancro da mama, como um método minimamente invasivo para a avaliação de metastização axilar, visando diminuir a morbilidade associada ao esvaziamento axilar completo, requer um método preciso para avaliação patológica intraoperatória. Esse método não foi ainda estabelecido. Imprints e corte de congelação do gânglio sentinela são os procedimentos comummente utilizados, apesar de uma sensibilidade e especificidade inferior à desejada. Actualmente, novas técnicas estão a ser desenvolvidas, que apesar da sua optimização, ainda não ultrapassam os resultados das utilizadas. Um total de 138 mulheres com cancro da mama, submetidas a cirurgia mamária por abordagem conservadora da axila, cuja utilização de imprints e cortes de congelação foram os métodos de avaliação intraoperatória do gânglio sentinela. Os diagnósticos dados pela observação dos cortes dos fragmentos do exame extemporâneo foram comparados com os obtidos nos cortes histológicos definitivos dos fragmentos fixados em formol e incluídos em parafina. Os resultados obtidos da avaliação do exame extemporâneo demonstraram sensibilidade de 79,1%, especificidade de 96,9%, com uma precisão de 91,4%. Não se obteve correlação entre os resultados do extemporâneo e os parâmetros de caracterização do exame extemporâneo e tumores. Os métodos, imprints e cortes de congelação, actualmente utilizados na nossa instituição apresentam bons resultados, mas a adopção de apenas um ou outro necessita de uma análise mais aprofundada dos dados relativos à metodologia utilizada nos extemporâneos, de forma a verificar a especificidade e sensibilidade individualizadas dos imprints e dos cortes de congelação. Se os imprints se revelarem semelhantes aos cortes de congelação, a sua utilização é preferencial uma vez que acarreta menores custos e são menos morosos. A implementação de novas técnicas será uma metodologia adoptar, pelos benefícios acrescidos, porém mais estudos e a optimização
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A sub adult Caretta caretta was found on the 23rd August, 2014 ca. 16 nautical miles south off S. Miguel Island, Azores (Northeast Atlantic), with a large pelagic trawl hook inside its mouth. The individual was kept in a basin of sea water and sent by boat to Terceira Island following instructions by the Azores Regional Government via the Environmental Authority in order to be examined by the author and, if possible, undergo the necessary hook removal procedures. In this note, we describe the surgical procedures and how the turtle was evaluated both pre- and post-surgery.
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The amount of fat is a component that complicates the clinical evaluation and the differential diagnostic between benign and malign lesions in the breast MRI examinations. To overcome this problem, an effective erasing of the fat signal over the images acquisition process, is essentials. This study aims to compare three fat suppression techniques (STIR, SPIR, SPAIR) in the MR images of the breast and to evaluate the best image quality regarding its clinical usefulness. To mimic breast women, a breast phantom was constructed. First the exterior contour and, in second time, its content which was selected based on 7 samples with different components. Finally it was undergone to a MRI breast protocol with the three different fat saturation techniques. The examinations were performed on a 1.5 T MRI system (Philips®). A group of 5 experts evaluated 9 sequences, 3 of each with fat suppression techniques, in which the frequency offset and TI (Inversion Time) were the variables changed. This qualitative image analysis was performed according 4 parameters (saturation uniformity, saturation efficacy, detail of the anatomical structures and differentiation between the fibroglandular and adipose tissue), using a five-point Likert scale. The statistics analysis showed that anyone of the fat suppression techniques demonstrated significant differences compared to the others with (p > 0.05) and regarding each parameter independently. By Fleiss’ kappa coefficient there was a good agreement among observers P(e) = 0.68. When comparing STIR, SPIR and SPAIR techniques it was confirmed that all of them have advantages in the study of the breast MRI. For the studied parameters, the results through the Friedman Test showed that there are similar advantages applying anyone of these techniques.
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Background: An asynchronous eLearning system was developed for radiographers in order to promote a better knowledge about senology and mammography. Objectives: to assess the learners’ satisfaction. Methods: Target population included radiographers and radiogr aphy students, in order to assess eLearning satisfaction according to different experience levels in breast imaging. Satisfaction was measured through a questionnaire developed especially for eLearning systems, using a seven - point Likert scale. Main topics related are content, interface, personalization and learning community. Results: Overall, 85% of learners were satisfied with the course and 87,5% considered that the course is successful. Main areas that were evaluated by most learners in a positive way were interface and content (between six and seven - point); on the other hand, learning community presented a wider distribution of answers . Conclusions: The course provides an overall high degree of learner satisfaction, thus providing more effective knowle dge gain on breast imaging for radiographers.
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The calculation of the dose is one of the key steps in radiotherapy planning1-5. This calculation should be as accurate as possible, and over the years it became feasible through the implementation of new algorithms to calculate the dose on the treatment planning systems applied in radiotherapy. When a breast tumour is irradiated, it is fundamental a precise dose distribution to ensure the planning target volume (PTV) coverage and prevent skin complications. Some investigations, using breast cases, showed that the pencil beam convolution algorithm (PBC) overestimates the dose in the PTV and in the proximal region of the ipsilateral lung. However, underestimates the dose in the distal region of the ipsilateral lung, when compared with analytical anisotropic algorithm (AAA). With this study we aim to compare the performance in breast tumors of the PBC and AAA algorithms.
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Mestrado em Radioterapia
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Purpose: Evaluate the type of breast compression (gradual or no gradual) that provides less discomfort to the patient. Methods and Materials: The standard projections were simulated [craniocaudal/(CC) and mediolateral-oblique/(MLO)] with the two breast compressions in 90 volunteers women aged between 19 and 86. The women were organised in groups according to the breast density. The intensity of discomfort was evaluated using the scale that have represented several faces (0-10) proposed by Wong Baker in the end of each simulation. It was also applied an interview using focus group to debate the score that were attributed during pain evaluation and to identify the criteria that were considered to do the classification. Results: The women aged between 19-29y (with higher breast density) classified the pain during no gradual compression as 4 and the gradual compression as 2 for both projections. The MLO projection was considered the most uncomfortable. During the focus group interview applied to this group was highlighted that compression did not promoted pain but discomfort. They considered that the high expectations of pain did not correspond to the discomfort that they felt. Similar results were identified for the older women (30-50y; > 50y). Conclusion: The radiographers should considerer the technique for breast compression. The gradual compression was considered for the majority of the women as the most comfortable regardless of breast density. The MLO projection was considered as uncomfortable due to the positioning (axila and inclusion of pectoral muscle) and due to the higher breast compression compared to the CC projection.
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OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.
Fisioterapia no tratamento das mulheres Angolanas com cancro da mama no Centro Nacional de Oncologia
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Mestrado em Fisioterapia
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Human epidermal growth factor receptor 2 (HER2) is a breast cancer biomarker that plays a major role in promoting breast cancer cell proliferation and malignant growth. The extracellular domain (ECD) of HER2 can be shed into the blood stream and its concentration is measurable in the serum fraction of blood. In this work an electrochemical immunosensor for the analysis of HER2 ECD in human serum samples was developed. To achieve this goal a screen-printed carbon electrode, modified with gold nanoparticles, was used as transducer surface. A sandwich immunoassay, using two monoclonal antibodies, was employed and the detection of the antibody–antigen interaction was performed through the analysis of an enzymatic reaction product by linear sweep voltammetry. Using the optimized experimental conditions the calibration curve (ip vs. log[HER2 ECD]) was established between 15 and 100 ng/mL and a limit of detection (LOD) of 4.4 ng/mL was achieved. These results indicate that the developed immunosensor could be a promising tool in breast cancer diagnostics, patient follow-up and monitoring of metastatic breast cancer since it allows quantification in a useful concentration range and has an LOD below the established cut-off value (15 ng/mL).
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Background: Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services. Objective: Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy , effectiveness, and user satisfaction. Methods: A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis. Results: A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students’ posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful. Conclusions: This e-learning course is effective, especially for radiographers, which highlights the need for continuing education.
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More than ever, there is an increase of the number of decision support methods and computer aided diagnostic systems applied to various areas of medicine. In breast cancer research, many works have been done in order to reduce false-positives when used as a double reading method. In this study, we aimed to present a set of data mining techniques that were applied to approach a decision support system in the area of breast cancer diagnosis. This method is geared to assist clinical practice in identifying mammographic findings such as microcalcifications, masses and even normal tissues, in order to avoid misdiagnosis. In this work a reliable database was used, with 410 images from about 115 patients, containing previous reviews performed by radiologists as microcalcifications, masses and also normal tissue findings. Throughout this work, two feature extraction techniques were used: the gray level co-occurrence matrix and the gray level run length matrix. For classification purposes, we considered various scenarios according to different distinct patterns of injuries and several classifiers in order to distinguish the best performance in each case described. The many classifiers used were Naïve Bayes, Support Vector Machines, k-nearest Neighbors and Decision Trees (J48 and Random Forests). The results in distinguishing mammographic findings revealed great percentages of PPV and very good accuracy values. Furthermore, it also presented other related results of classification of breast density and BI-RADS® scale. The best predictive method found for all tested groups was the Random Forest classifier, and the best performance has been achieved through the distinction of microcalcifications. The conclusions based on the several tested scenarios represent a new perspective in breast cancer diagnosis using data mining techniques.
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RESUMO - O cancro da mama é uma preocupação da saúde pública a nível mundial, pela sua incidência, mortalidade e custos económicos associados. As terapias utilizadas no seu tratamento, embora eficazes, conduzem a alterações de todas as dimensões da Qualidade de Vida (QdV) da mulher com cancro da mama. A garantia de uma qualidade de serviço prestado deve ser uma prioridade das organizações de saúde, sendo a QdV uma medida de resultado. Partindo do pressuposto que em Portugal existe uma diferença potencial na forma como as mulheres com cancro da mama recebem o apoio por parte da fisioterapia, importa saber se a fisioterapia tem ou não influência na QdV da mulher com cancro da mama, o que, no caso de ser afirmativo, poderá constituir uma mais-valia para a qualidade do serviço prestado em oncologia. O Objectivo deste trabalho é construir um modelo de análise no sentido de responder à questão inicial de investigação: “Será que a fisioterapia contribui para a melhoria da Qualidade de Vida das mulheres com cancro da mama submetidas a cirurgia e outras terapias oncológicas?”. Neste sentido o trabalho de projecto dividiu-se por etapas. Inicialmente foi realizado um enquadramento teórico, através de uma revisão de literatura e da realização de entrevistas exploratórias, permitindo desta forma ter um conhecimento actual das temáticas que definem as variáveis e o objecto de estudo. Na etapa seguinte, foi feita uma análise crítica sobre o conhecimento actual do tema em estudo, que permitiu definir as variáveis a estudar, escolher o instrumento de medida a utilizar, ter conhecimento dos procedimentos a seguir. Após a definição do objectivo geral (avaliar se a fisioterapia tem influência na QdV das mulheres submetidas a cirurgia e outras terapias oncológicas) e dos objectivos específicos, iniciou-se o delineamento da metodologia tida como adequada para responder às questões de investigação levantadas (tipo de estudo, as variáveis, a unidade de análise, os métodos e técnicas de recolha de dados, os procedimentos e a metodologia de tratamento de dados). No âmbito do trabalho de projecto está definida a colocação em campo de um caso de estudo efectivo que permita dar um contributo real no delineamento da metodologia. Neste trabalho optou-se pela realização de um estudo piloto, que se enquadra nos procedimentos da metodologia e que teve por objectivo retirar algumas conclusões sobre: a aplicabilidade do instrumento de medida; os tempos definidos para a recolha de dados; as características sociodemográficas e clínicas da amostra; as questões de investigação levantadas. O estudo piloto consistiu num estudo pré-experimental, com uma amostra de 35 indivíduos, submetidos a cirurgia a cancro da mama e a outras terapias oncológicas. Foram avaliadas as dimensões do bem-estar físico e actividades quotidianas, bem-estar psicológico, relações sociais, sintomas e características sociodemográficas/clínicas, no início do tratamento individual de fisioterapia e no momento de alta. Utilizou-se como instrumento de medida o questionário EORTC QLQ–30 e o seu questionário complementar EORTC QLQ–23. Tendo sido construída uma ficha para recolha de dados sociodemográficos e clínicos. A significância estatística foi aceite para valores de p<0,05. Para comparação entre grupos e evolução dentro de cada grupo aplicou-se o teste t-student e o teste de Mann-Whitney. A análise dos resultados do estudo piloto permitiu verificar que: - O instrumento de medida proposto (questionário EORTC QLQ30 e BR23) mostrou ser de fácil aplicação, não tendo existido dificuldade por parte das doentes no seu preenchimento. Não houve problemas no cálculo dos scores e na sua interpretação; - Parte considerável das mulheres com cancro da mama será submetida a protocolos que se poderão prolongar por vários meses após a cirurgia (ex: QT+RT+HT). Esta realidade leva-nos a propor que sejam realizados vários momentos de avaliação, para que possam ser avaliadas as dimensões da QdV ao longo dos diferentes protocolos de tratamentos. Pensamos que o ideal seria a realização de 4 momentos de avaliação (3 a 4 semanas após a cirurgia, 3 meses, 6 meses e 9 meses após cirurgia). Sugerimos também que o estudo proposto seja realizado com uma amostra de maior dimensão; - O estudo piloto como recorreu a uma metodologia pré-experimental (ausência de grupo de controlo e apenas dois momentos de avaliação), não permite a consistência dos resultados; no entanto os resultados obtidos podem constituir um indicador de que a fisioterapia tem influência nas diferentes dimensões da QdV da mulher com cancro da mama submetida a cirurgia e a outras terapias oncológicas, podendo constituir uma mais-valia para a qualidade do serviço prestado em oncologia. Os resultados do estudo piloto permitiram redefinir a metodologia tida como adequada para responder à questão de investigação inicial. Apresentamos de seguida a mesma: Estudo quase-experimental, sendo a amostra constituída por dois grupos de 60 mulheres cada, submetidas a cirurgia a cancro da mama e a outras terapias oncológicas. O grupo experimental será submetido a tratamentos individuais de fisioterapia. Serão avaliadas as dimensões do bem-estar físico e actividades quotidianas, bem-estar psicológico, relações sociais e sintomas. A recolha de dados será realizada 3 semanas, 3 meses, 6 meses e 9 meses após a cirurgia. Como instrumento de medida será utilizado o questionário EORTC QLQ–30 e o seu questionário complementar EORTC QLQ–23, serão também recolhidos dados sociodemográficos e clínicos. A significância estatística será aceite para valores de p<0,05. Para comparação entre grupos e evolução dentro de cada grupo serão utilizados testes paramétricos e não paramétricos. A realização de um estudo que seguisse a metodologia acima referida permitiria uma maior consistência dos resultados, podendo eventualmente existir a confirmação de que a fisioterapia pode ter influência na QdV da mulher submetida a cirurgia a cancro da mama e a outras terapias oncológicas. A evidência de que a fisioterapia tem influência na QdV da mulher com cancro da mama, e o facto de a QdV ser um indicador da qualidade do serviço prestado em oncologia, poderão constituir um agente facilitador para a mudança na gestão de recursos humanos em organizações de saúde com a valência de oncologia, levando a uma alteração dos padrões de prática na área da fisioterapia em oncologia em Portugal, que poderá conduzir a uma melhor qualidade de serviço prestado ao doente oncológico. ----- ABSTRACT - Breast Cancer is a worldwide public health concern due to the incidence, mortality and economic costs associated. Although effective, therapies used in its treatment lead to changes in all Quality of Life (QoL) dimensions of a woman suffering from Breast Cancer. QoL is an outcome measure, and the insurance of quality of care provided should be a priority to health organizations. Taking into consideration that in Portugal there is a potential difference in the way women with Breast Cancer are provided with physical therapy, it is important to know whether physical therapy does or does not influence the QoL of women with breast cancer. If it does, it will lead to a health care quality improvement to cancer patients. The goal of the following study is to build an analysis model in order to answer the initial investigation question: “Does Physical Therapy contribute to enhance the Quality of Life of women with breast cancer who underwent surgery and other oncology treatments?” The project was divided in different stages. Initially, a literature revision was elaborated and exploratory interviews were held, which allowed an actual knowledge of the themes that define the variables and the object of study. The next stage included a critical analysis of the theme, which allowed the definition of variables of study, the choice of instrument of measure and the acquisition of some knowledge on how to proceed. After the definition of the general goal (to evaluate the influence of physical therapy on the QoL of women with breast cancer who underwent surgery and other oncology treatments) and specific goals, the choice of a right methodology took place, in order to answer the investigation questions (type of study, variables, unit analysis, methods and techniques on data collection, procedures and data treatment). In the scope of the project, it is decided to put out on the field an effective case-study which assures a real contribution on the choice of te methodology. In this particular work, there was a pilot study, included in the methodology procedures, with the goal of obtaining conclusions on the applicability of the instrument of measure; the length of time to collect data, the socio-demographic and clinical characteristics of the sample; the investigation questions. The pilot study consisted on a one group pretest-postest design, with a sample of 35 individuals who underwent surgery and other oncology treatments. Dimensions such as physical well-being and everyday life activities, psychological well-being, social relationships, symptoms and socio-demographical/clinical characteristics were assessed at the beginning of physical therapy individual treatment and at the moment of release. The instrument of measure used was the EORTC QLQ–30 questionnaire and its complementary questionnaire EORTC QLQ–23. A chart was made in order to collect socio-demographic and clinical data. Statistic significance was accepted for values of p<0,05. To compare between groups and to detect the evolution within each group, the t-student test and the Mann-Whitney test were applied. The outcome analysis of the pilot study allowed to verify that: - The instrument of measure proposed (EORTC QLQ30 and BR23) was easy to apply, and the subjects did not show any difficulty in filling it up. There was also no problem on calculating the scores or interpreting them; - A considerable part of the women with breast cancer will be submitted to protocols that may occur throughout several months after surgery (e.g., QT+RT+HT). This reality leads us to suggest several moments of assessment of the QoL dimensions in various moments of the different protocol treatments. We consider that the ideal number of evaluations would be 4 (3/4 weeks, 3 months, 6 months and 9 months after surgery). We also suggest the use of a larger sample; - Since the pilot study resorted to a one group pretest-postest design (there is an absence of control group and only two moments of assessment), there is no consistency of outcome. However, the results obtained indicate that physical therapy influences the dimensions of QoL on women with breast cancer who underwent surgery and other oncology treatments, which may be an asset to the quality of care provided to cancer patients. The outcome of the pilot study allowed to redefine the methodology given as adequate to answer the initial investigation question. Our suggestion is as follows: quasi-experimental design, with a sample of 120 subjects (2 groups of 60 women) with breast cancer who underwent surgery and other oncology treatments. The experimental group will be submitted to individual treatments of physical therapy. Dimensions such as physical well-being and everyday life activities, psychological well-being, social relationships and symptoms will be assessed. The collection of data will occur at 3 weeks, 3 months, 6 months and 9 months after surgery. The instrument of measure is the EORTC QLQ–30 questionnaire and its complementary questionnaire EORTC QLQ–23, and social-demographic and clinical information will also be collected. The statistic significance will be accepted for values of p<0,05. Parametric and non-parametric tests will be used to compare between groups and to detect the evolution within each group. Carrying out a study that followed the methodology discussed above would allow a better consistency of results, possibly enabling the confirmation that physical therapy influences the QoL of women with breast cancer who underwent surgery and other oncology treatments. The evidence that physical therapy influences the QoL of women with breast cancer, and the fact that QoL is an indicator of quality of care provided to cancer patients, may work as a facilitating agent in the change of human resources management in health organizations associated to oncology, which will lead to a change in oncology physical therapy practice patterns in Portugal, guiding to a health care quality improvement to cancer patients.
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A 66-year-old female with Streptococcus viridans aortic and tricuspid infective endocarditis develops, during the course of antibiotic therapy, rupture of a right coronary sinus of Valsalva aneurysm to the right ventricle. An urgent cardiac surgery is preformed with implantation of a mechanical aortic prosthesis and a right coronary sinus plasty. Six months later a huge aortic pseudoaneurysm is diagnosed and she is submitted to a second uneventful surgery. A review is done for the significant features with discussion of diagnosis and therapy.
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This work presents the development of a low cost sensor device for the diagnosis of breast cancer in point-of-care, made with new synthetic biomimetic materials inside plasticized poly(vinyl chloride), PVC, membranes, for subsequent potentiometric detection. This concept was applied to target a conventional biomarker in breast cancer: Breast Cancer Antigen (CA15-3). The new biomimetic material was obtained by molecularly-imprinted technology. In this, a plastic antibody was obtained by polymerizing around the biomarker that acted as an obstacle to the growth of the polymeric matrix. The imprinted polymer was specifically synthetized by electropolymerization on an FTO conductive glass, by using cyclic voltammetry, including 40 cycles within -0.2 and 1.0 V. The reaction used for the polymerization included monomer (pyrrol, 5.0×10-3 mol/L) and protein (CA15-3, 100U/mL), all prepared in phosphate buffer saline (PBS), with a pH of 7.2 and 1% of ethylene glycol. The biomarker was removed from the imprinted sites by proteolytic action of proteinase K. The biomimetic material was employed in the construction of potentiometric sensors and tested with regard to its affinity and selectivity for binding CA15-3, by checking the analytical performance of the obtained electrodes. For this purpose, the biomimetic material was dispersed in plasticized PVC membranes, including or not a lipophilic ionic additive, and applied on a solid conductive support of graphite. The analytical behaviour was evaluated in buffer and in synthetic serum, with regard to linear range, limit of detection, repeatability, and reproducibility. This antibody-like material was tested in synthetic serum, and good results were obtained. The best devices were able to detect 5 times less CA15-3 than that required in clinical use. Selectivity assays were also performed, showing that the various serum components did not interfere with this biomarker. Overall, the potentiometric-based methods showed several advantages compared to other methods reported in the literature. The analytical process was simple, providing fast responses for a reduced amount of analyte, with low cost and feasible miniaturization. It also allowed the detection of a wide range of concentrations, diminishing the required efforts in previous sample pre-treating stages.