Eficácia dos exercícios para ombro nas complicações loco-regionais em mulheres submetidas a radioterapia para câncer de mama: ensaio clínico

OBJECTIVE: To investigate the effect of shoulder exercises during radiotherapy in relation to prevention of locoregional physical complications: limitation of range of motion (ROM) and functional capacity, arm circumference and scar tissue adhesion. METHODS: Sixty-six women without shoulder ROM impairment following breast cancer surgery that included complete axillary dissection were allocated to one of two groups: 32 in the physical therapy group (PG) (52.7±10.2 years), who underwent an exercise program; and 34 in the control group (CG) (48±10.1 years). Shoulder ROM, upper-limb circumference and functional capacity and scar tissue adhesion were evaluated at the beginning and end of radiotherapy and six months after completing radiotherapy. RESULTS: The PG showed improvements in flexion and abduction ROM between the first and third evaluations (flexion from 164.77°±8.9° to 167.98°±9.5° and abduction from 168.56°±10.0° to 175.62°±10.2°), which was not observed in the CG (flexion from 167.06±06° to 165.16°±9.2° and abduction from 169.71°±10.1° to 169.53°±12.8°). There was a statistically significant increase in ROM in the PG in relation to the CG (flexion, p=0.02; and abduction, p=0.004). The circumference and functional capacity were similar between the groups and the frequency of scar tissue adhesion in the CG was twice that observed in the PG (48% versus 24%, p=0.04). CONCLUSIONS: These results suggest that shoulder exercises favor maintenance of flexion and abduction ROM of the shoulder and minimize the incidence of scar tissue adhesion in women undergoing radiotherapy for breast cancer treatment.OBJETIVO: Verificar o efeito da realização de exercícios para o ombro durante a radioterapia na prevenção de complicações físicas loco-regionais: limitação da amplitude de movimento (ADM) e da capacidade funcional, circunferência do braço e aderência cicatricial. MÉTODOS: Sessenta e seis mulheres sem comprometimento de ADM de ombro no pós-operatório de cirurgia para câncer de mama com dissecção axilar completa foram alocadas em dois grupos, sendo 32 no grupo de fisioterapia (GF) (52,7±10,2 anos), o qual foi submetido a um programa de exercícios, e 34 no grupo controle (GC) (48±10,1 anos). A ADM do ombro, a circunferência e capacidade funcional dos membros superiores e a aderência cicatricial foram avaliados no início e no final da radioterapia e seis meses após seu término. RESULTADOS: O GF apresentou melhora da ADM de flexão e abdução entre a primeira e terceira avaliação (Flexão: de 164,77°±8,9° para 167,98°±9,5° e Abdução: 168,56°±10° para 175,62°±10,2°), o que não se observou no GC (Flexão: 167,06°±6° para 165,16°±9,2° e Abdução: 169,71°±10,1° para 169,53°±12,8°), demonstrando uma melhora significativa do GF em relação do GC (Flexão: p=0,02 e Abdução: p=0,004). A circunferência e a capacidade funcional foram similares entre os grupos e a frequência de aderência cicatricial no GC foi o dobro daquela observada no GF (48% e 24%, p=0,04). CONCLUSÕES: Esses resultados sugerem que exercícios para o ombro favorecem a manutenção da ADM de flexão e abdução de ombro e minimizam a incidência de aderência cicatricial em mulheres submetidas à radioterapia para tratamento por câncer de mama.13614

Acupuncture in the rehabilitation of women after breast cancer surgery - a case series

Objective To evaluate the effect of acupuncture on rehabilitation of motor function, reduction in lymphoedema and improvement in perceived heaviness and tightness in the arms of women who had undergone breast cancer surgery. Subjects and Methods Twenty nine women who had had mastectomy or segmentectomy with axillary dissection, presenting with lymphoedema and/or a decrease in movement amplitude of the upper limb ipsilateral to surgery were studied. The patients underwent 24 acupuncture sessions once a week from February to December 2004. The movement amplitude of shoulder flexion and abduction and circumferential measurements of the arm, forearm and wrist were evaluated before and after one, three and six months of treatment. Statistical analysis was performed by Friedman's test. Results Significant improvements in range of movement of shoulder flexion and abduction (P<0.001), degree of lymphoedema (P=0.016), and sense of heaviness and tightening (P<0.001) in the affected limb after six months of therapy were observed. For circumferential measurements of the arm, forearm and wrist, no significant improvement between the different periods of treatment was observed. Conclusions Acupuncture in rehabilitation after breast cancer surgery was shown to be associated with improvements in movement amplitude of the shoulder, symptoms of heaviness and tightness in the arm, and the degree of lymphoedema. However, controlled trials should be performed to ascertain whether the results were due to the natural history of the complaint or the acupuncture treatment.262869

Forsikring mod Arbejdsløshed i Gent.

The treatment of cervical microinvasive carcinoma is controversial. Hysterectomy is performed in almost all cases, associated or not with more radical procedures. Currently, there is a tendency to adopt conservative management to treat patients with early invasion, as long as it can be assured that the whole lesion has been removed. The aim of this study was to establish which histological information should be obtained from the cones that would give the best possible assurance of absence of residual neoplasia in the patient. This was done by comparing cone and hysterectomy specimens from each patient. One hundred sixty-three cases, treated from 1967 to 1994, underwent simple or radical hysterectomy following tone biopsy. We evaluated the following histological features in the cones: (i) invasion depth, (ii) lateral extension of the lesion, (iii) unifocal or extensive lesion, (iv) vascular invasion, (v) morphological signs of HPV infection, and (vi) free or involved cone surgical margins. Residual neoplasia in the histerectomy was more frequent when the margins of the cone were involved by atypical epithelium, and in cases with signs of HPV infection. However, according to statistical analysis, these two variables were not mutually independent, and the only important parameter to predict residual neoplasia in the hysterectomy specimens was involved surgical margins in the cone. (C) 1997 Academic Press.65343744

Evaluation of lymphatic compensation by lymphoscintigraphy in the postoperative period of breast cancer surgery with axillary dissection

Objective. To evaluate postoperative lymphatic compensation in the upper limb after mastectomy with axillary dissection. Subjects and methods. Twenty-three patients who underwent lymphoscintigraphy before and 60 days after surgery were enrolled from September 2006 to June 2007, in Campinas, Brazil. Protocol examination consisted in static imaging of each upper limb in semi-flexion and thoracic imaging after 10 min and 1 and 2 hr after subcutaneous injection of 1 mCi (37 MBq) of (99m)Tc dextran into the dorsum of the hand. A comparative analysis was made of hepatic uptake of the radiopharmaceutical, velocity of axillary lymph node visualization (I, visible at 10 min; II, at 1 hr; III, at 2 hr; IV, not visible) and degree (intensity) of uptake (a, marked; b, moderate; c, mild; d, absent) before and 60 days after surgery. Results. In the preoperative period, 3 (13%) patients were considered to have an optimal pattern (Ia) and 2 (9%) showed total involvement (IVd). Compared to velocity in the postoperative period, 9 (39%) patients showed no difference, 5 (22%) improved, 9 (39%) became worse, and one was considerably worse. Regarding the degree, 10 (43%) patients showed no difference, 9 (39%) became worse, and 4 (17%) improved. Regarding classification, 2 (9%) patients had an optimal lymphatic pattern (Ia) and 3 (13%) had total involvement (IVd). No patient presented decreased hepatic uptake after surgical treatment. Conclusions. The study found relevant changes in preoperative and postoperative lymphoscintigraphy, demonstrating the existence of functional differences in the lymphatic system of the upper limb. Alterations in lymphatic drainage pattern may already be perceived 60 days postoperatively, as can signs of lymphovenous anastomoses.97330931

Immediate Breast Reconstruction With Transverse Latissimus Dorsi Flap Does Not Affect the Short-term Recovery of Shoulder Range of Motion After Mastectomy

Immediate breast reconstruction, depending on the surgical strategy, can result in anatomic modifications that may affect the shoulder apparatus. This study compares the recovery of shoulder range of motion (ROM), after mastectomy, in women with and without immediate breast reconstruction with latssimus dorsi flap (LDF). This was a prospective study with 87 women who underwent mastectomy (41 with LDF). Shoulder ROM was assessed with goniometry, with a universal full-circle manual goniometer, prior to surgery, and on a weekly basis during the first 4 weeks postoperatively. Reconstruction with LDF was not associated with a decrease in shoulder ROM (P = 0.84). By the end of the 4-week assessment program, women in both groups still had an average reduction of 30 degrees in their shoulder ROM compared with baseline. Factors significantly associated with a reduction in shoulder ROM during the recovery period were complete dissection of the axilla, current smoking behavior, and presence of painful axillary cords. It is likely that breast reconstruction with LDF has little or no effect on shoulder ROM in the immediate postoperative period. It is also possible that LDF effects (if any) are overridden by the major reduction (over 30% in the immediate postoperative period, subsiding partially during the first weeks postoperatively) in shoulder ROM caused by mastectomy.64440240

Serum Amyloid A Is Associated with Obesity and Estrogen Receptor-Negative Tumors in Postmenopausal Women with Breast Cancer

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Serum amyloid A (SAA) is an acute-phase protein and also an adipokine, which has been associated with the development and prognosis of breast cancer. In the present study, we investigated the association between obesity and SAA in postmenopausal women with breast cancer and its relationship with clinicopathologic characteristics of tumors. Patients were grouped as nonobese or overweight/obese based on body mass index (BMI) plus waist circumference measurement. Serum SAA concentrations were determined by high-sensitivity micro-latex agglutination tests, detected by nephelometry. Serum SAA concentrations were higher in overweight/obese (P = 0.008) patients and this condition was dependent on obesity (BMI and waist circumference), as further shown by multivariate linear regression analysis done for SAA (P = 0.01). Concentrations of SAA were also higher in patients with estrogen receptor-negative (ER-) tumors than in those with estrogen receptor-positive (ER+; P = 0.033). Our results suggest a possible role for SAA in the development and prognosis of obesity-related breast cancer. A follow-up study of this population to assess overall and disease-free survival is in course and should bring contribution to evaluate the clinical role of SAA in breast cancer in the context of obesity. Cancer Epidemiol Biomarkers Prev; 22(2); 270-4. (c) 2013 AACR.222270274Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)State University of Campinas Teaching and Research Support Foundation (Faepex/Unicamp), S. BrazilCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP [09/17084-7

Polymorphisms GSTMI and GSTTI and sporadic breast cancer mammographic features

INTRODUCTION. Enzymes of the Glutathione S-transferase system (GST) modulate the effects of exposure to several cytotoxic and genotoxic agents. The GSTMI and GSTTI genes are polymorphic in humans and their deletions have been associated to increased risk of many cancers, including breast cancer. OBJECTIVE: To evaluate the occurrence of homozygous deletions of the GSTMI and GSTTI genes in women with sporadic breast cancer and in women without cancer and to compare breast cancer mammographic features between patients with and without these deletions. METHODS: The study evaluated 100 patients with sporadic breast cancer treated from September 2004 to June 2005 and 169 women without cancer, determining the frequency of the above-mentioned deletions by PCR and calculating the odds ratios and their 95% confidence intervals. Medical files and mammograms of 100 patients with breast cancer were evaluated and correlated with mammographic features such as density, mammographic findings and the BI-RADS classification. These findings were correlated with the genetic deletions by the PR (Prevalence-Ratio) with their respective 95% confidence intervals. RESULTS: The GSTMI gene was deleted in 40% of the cancers and in 44.4% of controls(OR=1.20; CI 95% 0.70-2.04; p=05659) while the GSTTI gene was deleted in 20% and 19.5%, respectively(OR = 0.73;CI95% 0.37-1.44; p=0.4124). High mammographic density had been associated with GSTMI deletion (PR 2.43; CI 1.11 to 4.08). GST deletions were not associated with predominant mammographic findings and the BI-RADS classification. CONCLUSION: GSTMI homozygous deletion was associated with high mammographic density.541616

Two exercise schemes in postoperative breast cancer: Comparison of effects on shoulder movement and lymphatic disturbance

Aims and background: We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications. Currently, there are no guidelines for these exercises. The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises (directed or free) on shoulder function and lymphatic disturbance in postoperative rehabilitation. Subjects: Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were randomized into two groups. Methods: The physiotherapy technique used was kinesiotherapy. The directed group performed physiotherapy following a regimen of 19 exercises. The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions. Results: The averages of the flexion, abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group. There was no significant difference between the groups in lymphatic disturbance. Conclusion: At the end of 42 days of follow-up, the movements of flexion, extension, abduction and external rotation of the shoulder were better rehabilitated in the directed group. The two schemes of exercises were not different with regard to lymphatic disturbance.921556