Breast manifestations of systemic diseases

Although much emphasis has been placed on the primary presentations of breast cancer, little focus has been placed on how systemic illnesses may affect the breast. In this article, we discuss systemic illnesses that can manifest in the breast. We summarize the clinical features, imaging, histopathology, and treatment recommendations for endocrine, vascular, systemic inflammatory, infectious, and hematologic diseases, as well as for the extramammary malignancies that can present in the breast. Despite the rarity of these manifestations of systemic disease, knowledge of these conditions is critical to the appropriate evaluation and treatment of patients presenting with breast symptoms

The impact of vaginal laser treatment for genitourinary syndrome of menopause in breast cancer survivors : a systematic review and meta-analysis

Introduction Genitourinary syndrome of menopause (GSM) is caused by hypo-estrogenism, resulting in vaginal dryness, pain, dyspareunia, and urinary tract infection. It is more severe and common in breast cancer (BC) survivors owing to the severity of induced menopause following treatment (ie, chemotherapy, GnRH agonists/anti-estrogen therapy). It has a detrimental effect on quality of life. The gold standard therapy is topical estrogen, which is highly effective; however, it is contraindicated in patients with BC owing to concerns with recurrence. Recently, vaginal laser therapy has been used to restore vaginal mucosal thickness, lubrication, and elasticity with good effect in menopausal women with GSM. The aim of this study is to assess the impact of vaginal laser therapy on BC-associated GSM. Materials and Methods This study is a systematic review and meta-analysis. Results A total of 48 papers were identified, revealing 10 observational studies of GSM symptoms before and after vaginal laser therapy with no randomized trials. Vaginal laser was effective in treating GSM in BC survivors with improvement in the Vaginal Health Index and the Visual Analogue Scale score for dyspareunia and vaginal dryness, sexual function, and overall satisfaction in the short term with minimal adverse events. Conclusion Vaginal laser may be effective in treating GSM in BC survivors in the short term, but there are no long-term data on safety and efficacy. More research is needed looking at longer term follow-up, health economic costs, and sub-group analysis as well as the complex interplay between GSM and the other negative impacts of BC therapy on intimate relationships

‘Much Clearer with Pictures’: Using Community-Based Participatory Research to Design and Test a Picture Option Grid for Underserved Patients with Breast Cancer

Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer

Risk, responsibilities and rights: reassessing the ‘economic causes of crime’ thesis in a recession

This paper explores competing accounts of an apparent inversion of the previously-prevailing relationship between young people's unemployment and the incidence of youth offending at a time of economic recession. It begins by highlighting the faltering association between unemployment and offending, and considers the paradoxical implications for risk-based methodologies in youth justice practice. The paper then assesses explanations for the changing relationship that suggest that youth justice policies have successfully broken the unemployment-offending link; and alternatively that delayed effects of recession have yet to materialise, by reference to the work of four Inter-governmental organisations and to youth protests beyond the UK. In place of ever more intensive risk analyses, the paper then focusses on the adverse effects of unemployment on social cohesion, and proposes a rights-based approach to youth justice that recognises the growing disjuncture between the rights afforded to young people and the responsibilities expected of them

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O Problema Hospitalar em Lisboa

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