José Mendes Aldrighi

Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment.

Background: Although reduction mammaplasty is a well-described technique for aesthetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. The purpose of this study was to analyze the feasibility of the technique and its outcome following conservative breast surgery. Methods: Oncologic data and information on age, body mass index, smoking history, and comorbid conditions were collected. Reconstructed and opposite breast complications were evaluated. Reduction mammaplasty was indicated to reconstruct moderate breast defects in patients with enough remaining breast tissue. Mean follow-up was 22 months. Results: Seventy-four patients underwent immediate reduction mammaplasty following breast-conserving surgery. In 55.4 percent of patients, tumors measured 2 cm or less (T1) and in 47.2 percent they were located in the upper outer quadrants. Breast complications occurred in 13 patients (17.6 percent), with skin necrosis in six (8.1 percent), infection in two (2.7 percent), partial areola necrosis in two (2.7 percent), dehiscence in two, and total areola necrosis in one (1.35 percent). Late complications represented by skin lesions and fat necrosis were observed in five patients (6.8 percent). Obese patients and smokers had a significantly higher rate of reconstructed breast complications compared with the normal/overweight patients (p = 0.002) and nonsmokers (p = 0.043). No significant association between complications and age, hypertension, diabetes, axillary lymph node dissection, or chemotherapy was found. Conclusions: Reduction mammaplasty is a consistent technique for reconstruction following breast-conserving surgery. Complications are more often observed in the reconstructed breast, and obese patients and smokers are higher risk patients.

Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction.

Background: Aesthetic surgery of female genitalia is an uncommon procedure, and of the techniques available, labia minora reduction can achieve excellent results. Recently, more conservative labia minora reduction techniques have been developed, because the simple isolated strategy of straight amputation does not ensure a favorable outcome. This study was designed to review a series of labia minora reductions using inferior wedge resection and superior pedicle flap reconstruction. Methods: Twenty-one patients underwent inferior wedge resection and superior pedicle flap reconstruction. The mean follow-up was 46 months. Aesthetic results and postoperative outcomes were collected retrospectively and evaluated. Results: Twenty patients (95.2 percent) underwent bilateral procedures, and 90.4 percent of patients had a congenital labia minora hypertrophy. Five complications occurred in 21 patients (23.8 percent). Wound-healing problems were observed more frequently. The cosmetic result was considered to be good or very good in 85.7 percent of patients, and 95.2 percent were very satisfied with the procedure. All complications except one were observed immediately after the procedure. Conclusions: The results of this study demonstrate that inferior wedge resection and superior pedicle flap reconstruction is a simple and consistent technique and deserves a place among the main procedures available. The complications observed were not unexpected and did not extend hospital stay or interfere with the normal postoperative period. The success of the procedure depends on patient selection, careful preoperative planning, and adequate intraoperative management.

Prevalência do HPV em mulheres rastreadas para o câncer cervical

OBJECTIVE To assess the prevalence of high-risk genital human papillomavirus (HPV) infection by age group and risk factors associated. METHODS Cross-sectional study in a sample of 2,300 women (15-65 years old) who self-referred to cervical cancer screening in Sao Paulo and Campinas, Southeastern Brazil, between February 2002 and March 2003. An epidemiological questionnaire was applied and cervical specimens were obtained for cytology and hybrid capture II test (HCII) for HPV detection. Statistical analysis included Pearson Chi-square and unconditional multiple logistic regression model (forward likelihood ratio). RESULTS High-risk genital HPV infection prevalence in this sample was 17.8% and age distribution was as follows: 27.1% (<25 years), 21.3% (25-34 years), 12.1% (35-44 years), 12.0% (45-54 years) and 13.9% (55-65 years). Subjects with the highest number of lifetime sexual partners had the highest rates of genital HPV infection. To be living with a partner, aged 35 to 44 years, and former smokers were protective factors. High-risk genital HPV infection was 14.3% in normal cytology, 77.8% in high grade squamous intraepithelial lesions and in the two cases (100%) of cervical cancer. CONCLUSIONS High-risk HPV prevalence was high in the sample studied. The highest prevalence of HPV infection was seen in women under 25 years old and then a new increase was seen over the age of 55 and the highest rates were found among those with many sexual partners during their lifetime.

Rectal endoscopic ultrasound with a radial probe in the assessment of rectovaginal endometriosis.

STUDY OBJECTIVE To evaluate the accuracy of rectal endoscopic ultrasound and to evaluate endometriosis in the rectovaginal septum, rectum, and sigmoid walls. DESIGN Validation of diagnostic test (Canadian Task Force classification II-1). SETTING Tertiary care hospital. PATIENTS Thirty-two consecutive women clinically suspected of having rectovaginal septum endometriosis without previous surgical treatment. INTERVENTION Colonoscopy, transrectal ultrasound, and rectal endoscopic ultrasound, followed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS The disease was classified according to 1996 standards of the American Society of Reproductive Medicine. Images obtained by colonoscopy, endoscopic ultrasound, and surgery and histologic findings were compared. In 6 patients endometriosis infiltrated bowel muscularis wall, in 20 it infiltrated rectovaginal septum, and in the remaining 6 there was no evidence of lesions. In all women in whom infiltration of the intestinal wall was suspected, rectal endoscopic ultrasound and colonoscopy confirmed the lesions (sensitivity 100%, specificity 67%). CONCLUSION Endoscopic ultrasound was useful in preoperative assessment of women with endometriosis.

Histological classification of endometriosis as a predictor of response to treatment.

Objectives: To evaluate the usefulness of the histological classification of endometriosis in predicting responses to treatment. Methods: We evaluated 412 biopsy specimens from 241 patients with pelvic endometriosis. Pain and infertility were evaluated before surgery. Disease location and stage of development were analyzed according to the 1985 American Society of Reproductive Medicine (ASRM) classification. Histological findings were classified as stromal, well‐differentiated, undifferentiated, and mixed endometriosis. Clinical response to pain or infertility was evaluated. Results: Histological findings, disease location and stage of development, and response to treatment were compared. Undifferentiated endometriosis was more frequently associated with stages III/IV than the well‐differentiated and stromal histological types. Pure or mixed undifferentiated patterns were more frequently associated with rectovaginal endometriosis. When considering pain symptoms, patients presenting well‐differentiated or stromal histological patterns responded better to therapeutic treatment than those who presented undifferentiated histological patterns. There were no significant differences in cases related to sterility. Conclusions: The histological categorization of endometriosis can help predict the behavioral patterns of the disease.

Systemic sclerosis and bone loss: the role of the disease and body composition

Objectives: Studies on body composition are not available in systemic sclerosis (SSc). As this variable may play an important role in bone loss we have analysed bone mineral density (BMD) and body composition in SSc patients and healthy controls. Methods: Forty‐three postmenopausal SSc patients and 47 healthy postmenopausal women were studied. Patients with intestinal malabsorption, renal failure, current or past history of smoking or using osteopenic drugs were excluded. BMD and body composition was evaluated by dual X‐ray absorptiometry (DXA). Results: A higher frequency of osteoporosis in the lumbar spine (32.5%) and femoral neck (51.1%) was observed in SSc patients when compared to controls (14.8% vs. 19.1%; p<0.01). Multiple linear regression analysis revealed an association between the presence of SSc and low BMD. Body composition showed a reduced lean mass (33.15 vs. 39.99 g; p<0.01) and fat mass (21.05 vs. 26.82 g; p<0.01) in SSc when compared to controls. Lean mass was an important factor related to BMD in the lumbar spine and femoral neck. Conclusion: SSc may be an independent factor for low BMD. The low lean mass in these patients emphasizes the need for appropriate additional therapeutic measures to reduce bone loss in SSc patients.

The role of the lateral thoracodorsal fasciocutaneous flap in immediate conservative breast surgery reconstruction.

Background: Although the lateral thoracodorsal fasciocutaneous flap is a well-studied procedure for late breast reconstruction following radical surgery, there are few previous reports regarding its indication, flap design, and clinical outcome following conservative breast surgery. Methods: Thirty-four patients underwent immediate unilateral lateral thoracodorsal fasciocutaneous flap breast reconstructions. Mean time of follow-up was 23 months. The lateral thoracodorsal fasciocutaneous flap was indicated to reconstruct moderate lateral breast defects where there was not enough breast tissue to perform the reconstruction. Flap and donor-site complications were evaluated. Information on aesthetic results and patient satisfaction was collected. Results: All tumors were located in lateral breast regions, and 64.7 percent measured 2 cm or less (T1). Flap complications occurred in four patients (11.8 percent), with partial flap necrosis in three (8.8 percent). Donor-site complications occurred in eight (23.5 percent), with seroma in five (14.7 percent) and wound dehiscence in three (8.8 percent). The cosmetic result was considered to be good or very good in 88.2 percent, and the majority of patients were either very satisfied or satisfied. Surgical intervention was necessary in two cases of wound dehiscence. Serial dorsal puncture in cases of seroma were performed with satisfactory results. Conclusions: The lateral thoracodorsal fasciocutaneous flap is a simple and reliable technique for conservative breast surgery reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.

Quality of Life in Breast Cancer Survivors

O câncer de mama e uma das neoplasias mais comuns entre mulheres. O diagnostico e a terapia antineoplasica determinam repercussoes sociais, economicas, fisicas, emocionais/psicologicas e sexuais. Os principais parâmetros empregados na avaliacao dos resultados da terapia antineoplasica sao a sobrevida livre de doenca e a sobrevida global. Mais recentemente, a qualidade de vida (QV) tem sido considerada mais um desses parâmetros. Nao existe consenso quanto a definicao de QV. Porem, a maioria das definicoes contempla os aspectos multidimensional e subjetivo da QV. A identificacao dos fatores relacionados a QV e a compreensao da forma como esses fatores contribuem para a percepcao da QV sao motivos de discussao, uma vez que o conceito de QV esta diretamente relacionado ao contexto sociocultural em que o individuo esta inserido. A idade ao diagnostico, uso de quimioterapia, tipo de cirurgia, sintomas climatericos, relacionamento conjugal e sexualidade sao alguns fatores associados a QV de mulheres com câncer de mama. A QV associada a diferentes terapias antineoplasicas pode auxiliar pacientes e medicos na escolha da melhor modalidade terapeutica. Nesse sentido, o presente artigo revisa diversos aspectos da QV de mulheres com câncer de mama, apresentando e discutindo o estado atual do conhecimento sobre o tema.

Periareolar Skin-sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Background: Although use of the latissimus dorsi myocutaneous flap associated with the Biodimensional anatomical expander implant system (McGhan 150) is a reliable technique, little information has been available regarding clinical outcome following periareolar skin-sparing mastectomy reconstruction. The purpose of this study was to analyze the feasibility of the technique, surgical planning, and its outcome following skin-sparing mastectomy. Methods: Thirty-two patients underwent immediate unilateral latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system breast reconstruction. Mean follow-up was 18 months. The technique was indicated in patients with small- or moderate-volume breasts with or without ptosis, in whom the use of abdominal flaps was precluded. Flap and donor-site complications were evaluated. Information on anesthetic results and patient satisfaction was collected. Results: Seventy-two percent had tumors measuring 2 cm or less (T1) and 78 percent were stage 0 and I according to American Joint Committee on Cancer criteria. Breast skin complications occurred in 9.4 percent. Two patients presented small breast skin necrosis, and in one patient, a wound dehiscence was observed. Donor-site complications, all represented by seroma, occurred in 12.5 percent. The cosmetic result was considered good or very good in 84.4 percent, and the majority of patients were either very satisfied or satisfied. No local recurrences were observed. All complications except two were treated by conservative means. Conclusions: The latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system is a simple and reliable technique for periareolar skin-sparing mastectomy reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative and postoperative management.

Qualidade de vida em usuárias e não usuárias de terapia de reposição hormonal

OBJECTIVE. To compare the quality of life in postmenopausal women who were users and non-users of hormone replacement therapy (HRT). METHODS. A cross-sectional study was conducted on postmenopausal women aged between 40 and 65 years, who had been menopausal for up to 15 years. Women considered HRT users were those who had undergone this type of treatment for at least six months. Non-users of HRT were those who had not received this type of treatment during the last six months. Two hundred and seven women were included in the study: 106 users and 101 non-users of HRT. Sociodemographic, clinical and behavioral characteristics were assessed. The Kupperman Menopausal Index was applied to rate the intensity of climacteric symptoms and the Medical Outcomes Study 36- item Short-Form Health Survey (SF-36) was applied to assess women’s quality of life. For data analysis, a Student’s t test, a chi-square analysis, a Fisher’s exact test and a Mann-Whitney test were used. RESULTS. The mean age of HRT users was 52.6 ± 4.9 years and the mean age of non-users of HRT was 54.3 ± 4.7 years (p=0.01). There was a statistically significant difference regarding marital status (p=0.04). HRT users reported a lower frequency of moderate and severe climacteric symptoms (p=0.001). Of the eight quality of life domains evaluated, only vitality scored below 50 (45) in both groups. There were no differences between groups regarding the SF-36 components. CONCLUSIONS. Postmenopausal women who were users and non-users of HRT presented a good quality of life. There were no differences between users and non-users of hormone therapy.