Carlos Alberto Ruiz

Reassurance in the Treatment of Mastalgia

▪ Abstract: The purpose of the study was to evaluate the results of the application of a nonpharmacologic treatment based on explanations and reassurance to women with mastalgia. A total of 121 women were studied. They received reassurance and underwent follow up with a questionnaire 2–3 months later. An original methodology to evaluate the efficiency of mastalgia treatment was employed, which consisted of comparing pain parameters of the patients before and after treatment. The authors verified a success rate of 70.2% (n = 85) with reassurance. When evaluating the intensity of the symptom, reassurance was effective in 85.7% of the patients with a mild form of mastalgia, in 70.8% with a moderate form, and in 52.3% with a severe form. It was concluded that reassurance should be the first‐line treatment for women with mastalgia. Drug prescriptions are indicated only in patients refractory to this form of management. ▪

Clinical and morphological factors predictive of occult involvement of the nipple-areola complex in mastectomy specimens

OBJECTIVE To evaluate characteristics predictive of nipple-areola complex (NAC) involvement by the breast tumor. STUDY DESIGN Cases of infiltrative ductal carcinoma (stages I, IIA and IIB) treated by mastectomy in which the distance between the tumor and the NAC was >or=2 cm were included. NAC involvement was evaluated using serial histological sections. The distance between the tumor and the NAC was measured on mammograms. Other parameters taken into consideration were: tumor size, histological and nuclear grades, vascular invasion, and the presence of an in situ component. For comparisons between categorical variables, the chi-square test or Fishers exact test were used. Students t-test was used for numerical variables with normal distribution and the Mann-Whitney U-test was applied when distribution was not normal. RESULTS Fifty patients were included. NAC was affected in 12 and unaffected in 38. There was no statistically significant difference in mean age between the unaffected and affected groups (58.9+/-13.5 years versus 55.8+/-12.5 years, p=0.477); however, 13.2% and 58.3% (p=0.046) in the NAC-unaffected and NAC-affected groups, respectively, were <50 years of age. Distance <or=3 cm between the tumor and the NAC on mammograms was found in 60.5% of the NAC-unaffected group and in 100% of the NAC-affected group (p=0.007). With respect to the in situ component, there was a difference between the NAC-unaffected and NAC-affected groups regarding micropapillary pattern (13.2% versus 50.0%; p=0.014) and extensive in situ component (13.2% versus 41.7%; p=0.046). No statistically significant difference was found for any of the other parameters analyzed. CONCLUSIONS A distance between the tumor and the NAC <or=3 cm, age <50 years, and ductal carcinoma in situ with micropapillary pattern or with an extensive in situ component were factors significantly associated with a higher likelihood of NAC involvement.

Breast cancer screening in developing countries

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.

Cirurgia oncoplástica e reconstrutiva da mama: Reunião de Consenso da Sociedade Brasileira de Mastologia

Objetivo: Apesar do grande numero de publicacoes em cirurgia oncoplastica e reconstrutiva da mama, diversas questoes permanecem controversas. Assim, o objetivo desta Reuniao de Consenso, foi desenvolver um guia pratico de recomendacoes baseadas nas melhores evidencias disponiveis na literatura. Metodo: Os painelistas foram os membros da Comissao de Cirurgia Oncoplastica e Reconstrutiva da Sociedade Brasileira de Mastologia. A reuniao foi realizada em agosto de 2015 em Bento Goncalves (RS). Cada painelista recebeu e respondeu previamente um questionario com 46 itens, com base na melhor evidencia cientifica e em sua experiencia. Foi considerado consenso a concordância de 75% entre painelistas. Resultados: Houve consenso em 25 itens, dos quais para oito houve concordância de 100%. O mais importantes foram: compro- metimento das margens em cirurgia oncoplastica pode ser resolvido com ampliacao de margens na maioria dos casos; tumores multifocais nao sao contraindicacao para cirurgia oncoplastica; idade >70 anos nao representa contraindicacao para uso de tecnicas oncoplasticas; reconstrucao imediata pode ser indicada com seguranca para a maioria das candidatas a mastectomia; pa- cientes com indicacao de radioterapia pos-mastectomia podem ser submetidas a reconstrucao imediata, devendo ter ciencia dos riscos maiores para mau resultado estetico; mastectomia com preservacao do complexo areolopapilar e segura nos casos de câncer; radioterapia apos a mastec- tomia com preservacao do complexo areolopapilar nao esta indicada fora dos criterios classicos de irradiacao do plastrao; tela abdominal reduz chances de hernia no caso de reconstrucao com TRAM. Conclusao: atraves desta reuniao foi possivel estabelecer importantes pontos consensu- ais de acordo com a opiniao dos especialistas, que poderao auxiliar os mastologistas na tomada de decisoes em cirurgias oncoplasticas e reconstrutivas da mama.

Novel photorearrangement of a 4-chloromethylazulene

Abstract 1-Chloro-4,6,8-trimethylazulene is formed almost exclusively upon UV irradiation of a deaereted benzene solution of 4-chloromethyl-6,8-dimethylazulene. This photoproduct was identified by 1 H and 13 C NMR spectroscopy of both the isolated photoproduct and the one prepared by a thermal route. The mechanism proposed involves the recombination of the intimate radical pair initially formed by the photohomolysis of the CCl bond, followed by a sigmatropic [1,9] hydrogen shift.