Reconstrução mamária após mastectomia por neoplasia de mama: análise comparativa entre reconstrução precoce e tardia

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Florianópolis, 2016.Introdução: A reconstrução precoce com implantes definitivos pós-mastectomia por neoplasia de mama tem sido amplamente empregada, especialmente com a evolução dos tratamentos cirúrgicos do câncer de mama cada vez mais conservadores. Objetivos: Identificar diferentes características associadas à cirurgia plástica de acordo com o tempo de reconstrução: precoce ou tardio, e avaliar Qualidade de vida em pacientes submetidas a mastectomia por câncer. Métodos: Estudo analítico transversal, que avaliou indivíduos adultos submetidos a mastectomia por neoplasia de mama e reconstrução mamária no Serviço de Cirurgia Plástica de um hospital terciário. Resultados: Entre março de 2011 e novembro de 2015, 58 indivíduos submetidos à mastectomia foram incluídos, com média de idade de 51,6 ± 10,6 anos e 98,3% eram mulheres. Oitenta porcento dos pacientes foi submetida a mastectomia radical e 20% à segmentectomia. Reconstrução cirúrgica precoce ocorreu em 22,4% e tardia em 77,6% dos casos: reconstrução imediata com retalho local (15,5%); reconstrução imediata com implante de silicone gel (6,9%); retalho músculo-cutâneo transverso do reto abdominal (TRAM) (6,9%); reconstrução tardia com retalho local (8,6%), expansor e implante (39,7%); e reconstrução com retalho do grande dorsal e implante (22,4%). Quando se comparou os indivíduos submetidos à cirurgia de reconstrução precoce àqueles submetidos à reconstrução tardia, se observou que entre os indivíduos submetidos à cirurgia de reconstrução tardia das mamas, havia uma maior proporção de mastectomia radical (90,7% vs. 41,7%; p = 0,001), de duas ou mais intervenções cirúrgicas (64,1% vs. 20,0%; p = 0,029). Não se observou diferenças na Qualidade de vida, avaliada por meio do questionário WHOQoL-Bref, de acordo com o tempo de reconstrução. Conclusões: As características que se associam ao tempo de reconstrução pósmastectomia relacionam-se a fatores pré-operatórios, como a cirurgia empregada e o número de intervenções realizado e não têm influência nas complicações ou na Qualidade de vida.Abstract : Backgroud: Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery according to reconstruction time: immediate or delayed, and evaluate quality of life in patients undergoing mastectomy for cancer. Methods: Cross-sectional analytical study, which evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service in a tertiary hospital. Results: Between March 2011 and November 2015, 58 patients who underwent mastectomy were included with a mean age of 51.6 ± 10.6 years and 98.3% were women. Eighty percent of the patients underwent a radical mastectomy and 20% to segmentectomies. Immediate surgical reconstruction occurred in 22.4% and delayed reconstruction was reported in 77.6% of cases: immediate reconstruction with the local flap trade (15.5%); immediate reconstruction with prosthesis (6.9%); TRAM (transverse flap myocutaneous rectus abdominis) (6.9%); delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%); and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing individuals undergoing reconstructive surgery according to timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; p = 0.001), two or more surgical interventions (64.1% vs 20.0%; p = 0.029). There was no difference in the quality of life according to reconstruction time. Conclusions: The characteristics that are associated with post-mastectomy reconstruction timming are related to preoperative factors, such as the procedure employed and the number of interventions performed and have no influence on complications or quality of life

Highlights of unsteady pressure tests on a 14 percent supercritical airfoil at high Reynolds number, transonic condition

Steady and unsteady pressures were measured on a 2-D supercritical airfoil in the Langley Research Center 0.3-m Transonic Cryogenic Tunnel at Reynolds numbers from 6 x 1,000,000 to 35 x 1,000,000. The airfoil was oscillated in pitch at amplitudes from plus or minus .25 degrees to plus or minus 1.0 degrees at frequencies from 5 Hz to 60 Hz. The special requirements of testing an unsteady pressure model in a pressurized cryogenic tunnel are discussed. Selected steady measured data are presented and are compared with GRUMFOIL calculations at Reynolds number of 6 x 1,000,000 and 30 x 1,000,000. Experimental unsteady results at Reynolds numbers of 6 x 1,000,000 and 30 x 1,000,000 are examined for Reynolds number effects. Measured unsteady results at two mean angles of attack at a Reynolds number of 30 x 1,000,000 are also examined

Investigation and suppression of high dynamic response encountered on an elastic supercritical wing

The DAST Aeroelastic Research Wing had been previously in the NASA Langley TDT and an unusual instability boundary was predicted based upon supercritical response data. Contrary to the predictions, no instability was found during the present test. Instead a region of high dynamic wing response was observed which reached a maximum value between Mach numbers 0.92 and 0.93. The amplitude of the dynamic response increased directly with dynamic pressure. The reponse appears to be related to chordwise shock movement in conjunction with flow separation and reattachment on the upper and lower wing surfaces. The onset of flow separation coincided with the occurrence of strong shocks on a surface. A controller was designed to suppress the wing response. The control law attenuated the response as compared with the uncontrolled case and added a small but significant amount of damping for the lower density condition

Transition metal complexes containing chelating amido ligands

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Chemistry, 1998.Includes bibliographical references.by Scott William Seidel.Ph.D

Use of VaserTM plus liposuction in body contouring surgery

Introduction: Body contouring surgery is among the most requested surgical procedures in cosmetic surgery. Mentz was the first to perform superficial liposuction to define the abdominal muscles in male patients. However, Scuderi first popularized the use of continuous ultrasound to produce fat fragmentation in lipoplasty. Ultrasound, when applied internally to adipose tissue using a probe or metal cannula, breaks cells through three mechanisms: cavitation, thermal effect, and direct mechanical effect. Methods: Since November 2018, 50 patients with an indication for body liposuction performed the procedure with the help of the third-generation ultrasound equipment (VASER). Results: During the period between November 2018 and March 2019, 50 patients with a surgical indication underwent body contour liposuction using third-generation VASER technology. Of this universe of patients, 96% were women (47), with patients with an average age of 35 years (21-54). Conclusion: The association of VASER with liposuction is a safe and reproducible technique that has the advantage of improving the result of liposculpture. Good aesthetic results were achieved, with an athletic and more natural contour

Performance characteristics of a compact position-sensitive LSO detector module

We assembled a compact detector module comprised of an array of small, individual crystals of lutetium oxyorthosilicate: Ce (LSO) coupled directly to a miniature, metal-can, position-sensitive photomultiplier tube (PSPMT).We exposed this module to sources of 511-keV annihilation radiation and beams of 30- and 140-keV photons and measured spatial linearity; spatial variations in module gain, energy resolution, and event positioning; coincidence timing; the accuracy and sensitivity of identifying the crystal-of-first-interaction at 511 keV; and the effects of intercrystal scatter and LSO background radioactivity. The results suggest that this scintillator/phototube combination should be highly effective in the coincidence mode and can be used, with some limitations, to image relatively low-energy single photon emitters. Photons that are completely absorbed on their first interaction at 511 keV are positioned by the module at the center of a crystal. Intercrystal scatter events, even those that lead to total absorption of the incident photon, are placed by the module in a regular “connect-the-dot” pattern that joins crystal centers. As a result, the accuracy of event positioning can be made to exceed 90%, though at significantly reduced sensitivity, by retaining only events that occur within small regions-of-interest around each crystal center and rejecting events that occur outside these regions in the connect-the-dot pattern.The work was supported in part by a grant from CICYT (Spanish Government). The work of S. Siegel was supported by a grant from the National Research Council.Publicad

Depth identification accuracy of a three layer phoswich PET detector module

We describe a PET detector module that provides three levels of depth-of-interaction (DOI) information. The detector is a 9 x 9 array of 2 mm x 2 mm x 12 mm deep phoswich crystal elements, each consisting of 4 mm long LSO (entrance layer), GSO (middle layer) and BGO (exit layer) crystals joined optically together end-to-end. The BGO exit layer is directly coupled to a miniature position-sensitive photomultiplier tube (PSPMT). Delayed charge integration, a method that exploits differences in the light decay times of these scintillators, is used to determine the layer-of-interaction. DO1 accuracy, measured by scanning a slit source of 5 1 1 keV radiation along the length of the module was 86% for the LSO layer, 80% for the GSO layer and 84% for the BGO layer. Energy resolution at 511 keV was 19% for LSO, 21% for GSO and 40% for BGO. Apparent gain differed between layers in the ratios 2.7: 1.9: 1 .O (LS0:GSO:BGO). Crystal separation was good between crystals in the LSO layer, acceptable between crystals in the GSO layer and poor between crystals in the BGO layer due, primarily, to the pronounced spatial non-linearity of the PSPMT. The delayed charge integration method, however, does appear suitable for obtaining multi-level depth information when DO1 effects are particularly significant, e.g. in very small ring diameter PET scanners for small animal imaging.Was supported, in part, by a grant from CICYT (Spanish Government). S. S. was supported by a grant from the National Research Council.Publicad

Initial results from a PET/planar small animal imaging system

A pair of stationary, opposed scintillation detectors in time coincidence is being used to create planar projection or tomographic images of small animals injected with positronemitting radiotracers. The detectors are comprised of arrays of individual crystals of bismuth germanate coupled to position-sensitive photomultiplier tubes. The system uses FERA (LeCroy Research Systems) charge-sensitive ADCs and a low cost digital YO board as a E R A bus-to-host bridge. In projection mode, the animal is placed within the 55 mm x 45 mm useful field-of-view of the detectors and images are formed from coincidence lines that fall close to the normals of both detectors. In tomographic mode, the animal is placed on a rotation stage between the detectors and rotated around a vertical axis to acquire all possible lines-of-response. Tomographic images are then reconstructed from those lines falling within a user-specified angle of each detector normal. In mice, the system is capable of high-speed, whole-body dynamic projection imaging, and whole body tomographic imaging of slowly varying tracer distributions. An ECG gating capability is also available for evaluating cardiac function. This system is currently being used to study tracer transport in normal and genetically engineered mice.Publicad

An Introduction to Transient Engine Applications Using the Numerical Propulsion System Simulation (NPSS) and MATLAB

This document outlines methodologies designed to improve the interface between the Numerical Propulsion System Simulation framework and various control and dynamic analyses developed in the Matlab and Simulink environment. Although NPSS is most commonly used for steady-state modeling, this paper is intended to supplement the relatively sparse documentation on it's transient analysis functionality. Matlab has become an extremely popular engineering environment, and better methodologies are necessary to develop tools that leverage the benefits of these disparate frameworks. Transient analysis is not a new feature of the Numerical Propulsion System Simulation (NPSS), but transient considerations are becoming more pertinent as multidisciplinary trade-offs begin to play a larger role in advanced engine designs. This paper serves to supplement the relatively sparse documentation on transient modeling and cover the budding convergence between NPSS and Matlab based modeling toolsets. The following sections explore various design patterns to rapidly develop transient models. Each approach starts with a base model built with NPSS, and assumes the reader already has a basic understanding of how to construct a steady-state model. The second half of the paper focuses on further enhancements required to subsequently interface NPSS with Matlab codes. The first method being the simplest and most straightforward but performance constrained, and the last being the most abstract. These methods aren't mutually exclusive and the specific implementation details could vary greatly based on the designer's discretion. Basic recommendations are provided to organize model logic in a format most easily amenable to integration with existing Matlab control toolsets

Experiment assessment of mass effects in the rat_ implications for small animal PET imaging

In vivo imaging using positron emission tomography (PET) is important in the development of new radiopharmaceuticals in rodent animal models for use as biochemical probes, diagnostic agents, or in drug development. We have shown mathematically that, if small animal imaging studies in rodents are to have the same “quality” as human PET studies, the same number of coincidence events must be detected from a typical rodent imaging “voxel” as from the human imaging voxel. To achieve this using the same specifi activity preparation, we show that roughly the same total amount of radiopharmaceutical must be given to a rodent as to a human subject. At high specifi activities, the mass associated with human doses, when administered to a rodent, may not decrease the uptake of radioactivity at non saturable sites or sites where an enzyme has a high capacity for a substrate. However, in the case of binding sites of low density such as receptors, the increased mass injected could saturate the receptor and lead to physiologic effects and non-linear kinetics. Because of the importance of the mass injected for small animal PET imaging, we experimentally compared high and low mass preparations using ex vivo biodistribution and phosphorimaging of three compounds: 2-fluoro-2-deoxyglucos (FDG), 6-fluoro-L-metatyrosin (FMT) and one receptor-directed compound, the serotonin 5HT1A receptor ligand, trans-4-fluoro-N-{2-[4-(2-methoxylphenyl piperazino]ethyl}-N-(2- pyridyl) cyclohexane- carboxamide (FCWAY). Changes in the mass injected per rat did not affect the distribution of FDG, FMT, and FCWAY in the range of 0.6 –1.9 nmol per rat. Changes in the target to nontarget ratio were observed for injected masses of FCWAY in the range of 5–50 nmol per rat. If the specifi activity of such compounds and/or the sensitivity of small animal scanners are not increased relative to human studies, small animal PET imaging will not correctly portray the “true” tracer distribution. These difficultie will only be exacerbated in animals smaller than the rat, e.g., mice.Publicad