Abstract The purposes of the present research were to evaluate (1) the value of ultrasonographically guided fine-needle aspiration biopsy (US-FNAB) in nonpalpable suspicious breast lesions, (2) the preoperative use of methylene blue staining in nonpalpable galactographically suspicious breast lesions, (3) the determinants of positive histologic margins and residual cancer in wire-guided biopsy (WGB) of nonpalpable breast cancer and in lumpectomy for early breast cancer and the determinants of positive radiologic margins and the correlation between radiologic and histologic margins and residual disease in WGB of nonpalpable breast cancer, (4) the assessment of lumpectomy margins by touch preparation cytology in early breast cancer, and (5) the cosmetic outcome of WGB performed for benign breast lesions. The sensitivity and specificity of US-FNAB in 90 nonpalpable breast lesions were 84% and 93%, respectively. Preoperative methylene blue staining was successful in 22 out of 30 (73%) cases, making subsequent selective minimal volume microdochectomy easy to perform. Multivariate analysis of 21 prospectively evaluated variables was done after 71 WGBs of nonpalpable breast cancer followed by 54 re-excisions. Large mammographic lesions had more often positive radiologic margins. Multifocality, large pathologic size and superficial excision were related to positive histologic margins and multifocality to residual disease in re-excisions. The sensitivity and specificity of specimen radiography for predicting histologic margins were 38% and 81% and those for residual disease 27% and 79%, respectively. The corresponding figures for histologic margins in predicting residual disease were 85% and 59%, respectively. In a prospective series of 55 consecutive lumpectomies for early breast cancer, positive histologic margins were found more often in the presence of intraductal cancer and if the pathologic size of the index tumor was large. Residual disease was found in 38% of the cases with positive and in 15% of the cases with negative histologic margins. A multifocal and nonpalpable index tumor predicted residual cancer in 34 re-excision specimens. The sensitivity and specificity of touch preparation cytology in predicting histologic margins were 38% and 85%, respectively. In WGB, the overall cosmesis 6 months after surgery was satisfactory in 75 % of the 101 prospectively evaluated patients with benign proven lesions. Cosmesis was poorer after deep excisions and complications. The results indicate that US-FNAB is a useful tool in evaluating nonpalpable suspicious breast lesions. Preoperative methylene blue staining crucially facilitates selective minimal volume microdochectomy in three-quarters of cases. To obtain free margins in WGB, mammographically and pathologically large lesions should be removed with wider excisions extending down to the fascia. However, radiologic margins in WGB and histologic margins both in WGB and in lumpectomy for early breast cancer may be misleading. Re-excision of the biopsy site of multifocal tumors after WGB and lumpectomy should be considered. This is also important after superficial excision in WGB due to the considerable risk of residual disease. Touch preparation cytology cannot be recommended for the assessment of margins in lumpectomy specimens of early breast cancer. Cosmetic outcome after WGB of benign breast lesions is satisfactory in 75 % of cases. Deep excisions and complications endanger the cosmetic outcome. Preoperative biopsy and tumor localization methods have proven their utility; nevertheless, free margins are still difficult to obtain and to evaluate accurately. The surgeon may often be forced to choose between free margins and an acceptable cosmetic outcome.

No description available.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-08-17T16:23:30Z No. of bitstreams: 1 Marcela Olivieri.pdf: 1217846 bytes, checksum: 6268b7ab76dac68602b9e9becd7dbff1 (MD5) / Made available in DSpace on 2016-08-17T16:23:30Z (GMT). No. of bitstreams: 1 Marcela Olivieri.pdf: 1217846 bytes, checksum: 6268b7ab76dac68602b9e9becd7dbff1 (MD5) Previous issue date: 2016-02-17 / Prostate cancer is the 6th most common type of cancer worldwide and the 2nd most prevalent in Brazil so precocious diagnosis in the early stages can reduce its morbidity and mortality rates. Gender conceptions represent an important contribution to understanding of the cultural barriers of men to carry out the preventive examination, especially the digital rectal examination. Therefore, to reveal what men think and feel about the preventive examination will be able to subsidize new educative approaches regarding the adoption of preventive examinations. This study had as the main goal to investigate the social representations of men who search the Bus of the Men (Ônibus do Homem) about prostate cancer prevention. Twelve men were interviewed during the medical consultation carried by the Bus of the Men that goes through different neighborhoods of Sorocaba city in the state of São Paulo. The data collection was made by recorded oral interview gathering opinions, feelings and reasons for the adoption or refusal of the prostate cancer preventive examinations by the interviewees, as well as adoption and sociodemographic question form offered by the mobile unit. The interviews were organized according to a collective subject speech, and for the data analysis and interpretation a content analysis was used, subject area analysis mode. The results have shown that 41,7% of the participants go through preventive examinations regularly. The most quoted barrier to the digital rectal examinations were sexism, embarrassment and prejudice. The most quoted reasons to adopt the examination were the importance of prevention and maintenance as well as media influence. In order to have more men adopting the prevention the following was suggested: prostate cancer counseling to the resistant, dissemination of information about prevention and the silent evolution of cancer, demystification and recruiting / O câncer de próstata é o sexto tipo de câncer mais comum no mundo e o segundo mais prevalente no Brasil. Por isso a detecção precoce dos estágios iniciais pode reduzir taxas de morbidade e mortalidade. As concepções de gênero representam uma importante contribuição ao entendimento das barreiras culturais dos homens para a realização do exame preventivo, sobretudo o toque retal. Portanto desvelar o que os homens pensam e sentem sobre o exame preventivo do câncer de próstata poderá subsidiar novas abordagens educativas com vistas à adesão aos exames preventivos. O estudo teve como objetivo investigar, em homens que procuram o Ônibus do Homem, suas representações sociais sobre a prevenção do câncer de próstata. Foram entrevistados doze homens durante os atendimentos efetuados pelo Ônibus do Homem, que percorre diferentes bairros do município de Sorocaba, estado de São Paulo. A coleta de dados foi realizada por meio de entrevista oral gravada, buscando captar opiniões, sentimentos e motivos da adesão ou recusa dos entrevistados aos exames preventivos do câncer de próstata, além da aplicação de formulário sobre dados sociodemográficos e de adesão aos exames oferecidos pela unidade móvel. Os depoimentos foram organizados conforme a técnica do Discurso do Sujeito Coletivo. Para análise e interpretação dos dados foi utilizada a análise de conteúdo, modalidade de análise temática. Os resultados mostraram que 41,7% dos participantes realizam exames preventivos regularmente. As barreiras à realização do toque retal mais citadas foram o machismo, a vergonha e o preconceito; os indutores da adesão mais relatados foram a importância da prevenção, da manutenção do corpo, do exame para a prevenção, e a influência da mídia. Para que mais homens realizem a prevenção, foi sugerido: aconselhamento sobre o câncer de próstata aos resistentes, divulgação sobre a importância da prevenção e a evolução silenciosa do câncer, desmistificação e chamada para o exame, acesso a muita informação

This thesis analyzes the influence of specialized cancer hospitals in Florida on the outcomes of the mortality risk, length of stay, and charges of care among patients diagnosed with cancer, and performed a mastectomy, lumpectomy or radical prostatectomy, after controlling for age, gender, race, severity, type of hospital ownership, payment options, type of admission, and presence or absence of residency programs. The Florida Agency for Health Care Administration inpatient hospital discharge dataset of 2005 was used to extract data. Analysis of covariance was used to compute the differences on the three outcomes as a function of the specialization/volume of the treatment facility. The treatment facility categories were defined as (1) specialized cancer hospital; (2) general hospital with high volume (100 or more cancer treatment discharges per defined cancer); (3) general hospital with medium volume (50 to 99 cancer treatment discharges per defined cancer); (4) general hospital with low volume (25 to 49 cancer treatment discharges per defined cancer); and (5) general hospital with very low volume (less than 25 cancer treatment discharges per defined cancer). There were no deaths in any of the three procedures at specialized cancer hospitals. Being hospitalized at a specialty cancer hospital for a radical prostatectomy for prostate cancer was associated with 0.93 fewer days in mean length of stay (mean = 2.68 overall), but length of stay was not significantly different for mastectomy and lumpectomy (mean = 2.21 and 1.86 overall respectively) compared to general hospitals with very low volumes. Charges for care were not significantly different for lumpectomy and radical prostatectomy (mean = $22,097 and $25,220 overall respectively) for a specialty cancer hospital compared to general hospitals with very low volumes, where for mastectomies it was $4,850 on average lower (mean = $24,608 overall). In this study, patients managed at specialized cancer hospitals sometimes had better outcomes (i.e. shorter lengths of stay for radical prostatectomies and lower charges for mastectomies) compared to very low volume hospitals, while not having any significantly worse outcomes.

Att drabbas av cancer och genomgå cytostatikabehandling kan inverka på patienters sexualitet. Sjuksköterskor bör se till patienters alla behov för att kunna ge en god omvårdnad. Syftet var att beskriva sjuksköterskors reflektioner kring ämnet sexualitet i omvårdnadsarbetet med cytostatikabehandlade vuxna patienter med cancer. Studiens metod var empirisk med deskriptiv design och kvalitativ ansats. Datainsamlingen skedde via semi-strukturerade intervjuer med sex sjuksköterskor från en onkologisk klinik i Mellansverige. I huvudresultatet presenteras två kategorier, information om sexualitet vid start av cytostatikabehandling och omständigheter som påverkade samtal om sexualitet. Sjuksköterskorna ansåg att det var deras ansvar att informera om sexualitet och att information om ämnet var betydelsefullt. Patienters intresse och behov styrde informationen, men alla patienter fick inte information om sexualitet. Anledning till detta kunde vara att sjuksköterskorna inte ville genera patienter. Sjuksköterskorna hade inte erhållit någon kunskap om sexualitet genom utbildning. Kunskapen hade sjuksköterskorna erhållit genom arbetslivserfarenhet. Slutsats, för att som sjuksköterska regelbundet kunna informera patienter om hur sexualiteten kan påverkas av cytostatikabehandling vid cancersjukdom behövs vidare kunskaper. Detta för att kunna minska den spänning som finns kring ämnet sexualitet. / To suffer from cancer and going through treatment with chemotherapy can affect patients’ sexuality. Nurses should pay regard to all needs of the patients to be able to provide good nursing care. The aim of the study was to describe the nurses’ reflections around sexuality as a part of their nursing practice, related to adult patients with cancer going through chemotherapy. The study is based on qualitative interviews with a descriptive design. The interviews were conducted through semi-structured questions and the study group consisted of six nurses who worked at an oncology clinic in the central part of Sweden. The main result showed two categories, information about sexuality at the start of chemotherapy and circumstances that could affect conversation about sexuality. The nurses considered it to be their responsibility to inform the patient about sexuality and that information was meaningful. The patient’s interest and need directed the information, but all patients’ did not get information about sexuality. A reason to this could be that the nurses did not want to embarrass the patients. The nurses had not gained any knowledge about sexuality through education. The knowledge the nurses had gained came from work experience. Conclusion, to inform patients about how their sexuality can be affected by going trough treatment with chemotherapy regularly, nurses need further knowledge. This could reduce the tension that exists around the topic sexuality.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 9, 2009). Includes bibliographical references (p. 92-115).

Orientadores: Jose Antonio Simões, Sophie Françoise Mauricette Derchain / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T07:56:09Z (GMT). No. of bitstreams: 1 Campos_ElisabeteAparecida_M.pdf: 376476 bytes, checksum: 5cb1313dd5ebc4ab5d963f22dad4830d (MD5) Previous issue date: 2007 / Resumo: Objetivo: Avaliar a recuperação e estabilidade do DNA para detecção do papillomavírus humano (HPV) através da Reação em Cadeia da Polimerase (PCR) utilizando amostras estocadas por até 24 meses em Universal Collection Medium (UCM) com reagente desnaturante. Métodos: Sessenta amostras de citologia da cérvix uterina positivas para HPV, - que foram coletadas em UCM com resultado de Papanicolaou NIC 2 e NIC 3 entre os anos de 2003 e 2005 e que foram estocadas - foram utilizadas para este estudo. Todas as amostras haviam sido congeladas a ¿20°C após a adição do reagente desnaturante (0,05% de azida sódica + solução de NaOH) e da retirada da alíquota necessária para a realização do teste de Captura¿Híbrida 2 (CH 2) para identificação do DNA-HPV. O tempo de estocagem das amostras utilizadas foi de 6, 12 e 24 meses (20 amostras para cada tempo de estocagem). A extração do DNA foi realizada de acordo com protocolo específico para este tipo de material. A técnica de PCR foi realizada para confirmação da presença e da integridade do DNA através da detecção da ß-globina humana utilizando-se primers de consenso G73 e G74, e a detecção do DNA-HPV foi realizada utilizando-se os primers de consenso PGMY09 e PGMY11. Resultados: O DNA extraído do material desnaturado foi recuperado em 57 das 60 (95%) amostras estudadas. O DNA-HPV só não pôde ser detectado por PCR em uma destas amostras recuperadas. Conclusão: A recuperação e a estabilidade do DNA-HPV foi excelente após dois anos de estocagem do material cervical colhido em UCM com reagente desnaturan / Abstract: Objective: To evaluate the recovery and stability of DNA for the detection of HPV by Polymerase Chain Reaction (PCR) from clinical specimens stored for up to 24 months in Universal Collection Medium (UCM) with denatured reagent. Materials and methods: Sixty stores HPV-positive cervical smears collected from women with CIN 2 or CIN 3 diagnosis at Pap smear cytology between 2003 and 2005 were utilized to study. All samples were stored at ¿20°C after add of the denaturing reagent (sódica azida 0,05% and solution NaOH) and removing the aliquot required for carrying out the hybrid capture 2 assay for the identification of HPV-DNA, the samples were stored for 6, 12 or 24 months (20 samples for each storage time). DNA-HPV extraction was performed according to a protocol specifically designed for this type of material. The presence and quality of DNA was confirmed by human ß-globin detection using the consensus primers G73 and G74 and HPV was detected using the consensus primers PGMY09 and PGMY11 through the technique of PCR. Results: The DNA extracted from the denatured material was recovered in 57 out of 60 (95%) of the samples studied. DNA-HPV failed to be detected in one of the recovered samples. Conclusions: The recovery and stability of DNA-HPV from cervical samples stored for up to two years in UCM were excellent / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive, rare malignancy. Exact incidence is unknown due to lack of diagnostic criteria. Typically, it involves skin and bone marrow and less likely, lymph nodes and visceral organs. We present a 76 year old male who started having a lesion on the left side of his back that was progressively enlarging. He initially started on antibiotic and topical medications for more than a month which did not help. Punch biopsy of the lesion was consistent with blastic plasmacytoid dendritic cell neoplasm, positive for CD2, CD5, CD7, CD43, weak CD58,Tdt, bcl-6. Patient denies fever, chills, night sweats, weight loss, change in appetite. Physical exam revealed a purplish lesion raised in the left upper back with multiple satellite-like purple lesions throughout the back. Laboratory showed white cell count 3.2 K/uL, hemoglobin 13 g/dL, platelet 135 K/uL. Bone marrow biopsy shows immature blastic neoplasm involving 15% of the bone marrow. Cytogenetics showed normal karyotype. Flow cytometry shows an immature lymphoid population with expression of CD4, CD56, and CD 123, negative for FLT3, IDH1, IDH2, NPM1 mutations. Positron emission tomography (PET) scan showed skin thickening with minimal FDG uptake in left posterior skin soft tissue of the chest near the shoulder with no other abnormal focal uptake and splenomegaly. BPDCN is a rare aggressive malignancy that is more common in older populations. The origin is from type 2 dendritic cells. Typical presentations are skin lesions, cytopenia, lymphadenopathy, and splenomegaly. Some of the cytological features of BPDCN include cloudy sky (blue cytoplasm with clearer areas), pseudopods, and microvacuoles. Confirmation of diagnosis is with immunophenotyping. Workup after diagnosis include complete blood count, liver and renal function, hepatitis panel, peripheral blood smear, bone marrow evaluation, systemic imaging, cerebrospinal fluid cytology. Treatment of BPDCN is challenging in this era. Most patients respond to chemotherapy, although they relapse. Tegraxofusp is suggested for remission induction therapy following allogeneic hematopoietic cell transplantation. Median overall survival is about one year. Only patients who underwent hematopoietic stem cell transplant had prolonged survival. Myelemia, old age and altered general state have worse prognosis.

Os objetivos do presente trabalho foram avaliar a acurácia do exame ultra-sonográfico para indicar o órgão abdominal afetado pelo processo neoplásico, determinar as características ultra-sonográficas dos diferentes tipos neoplásicos que acometem o fígado, os intestinos e o pâncreas, bem como analisar a eficácia da ultra-sonografia bidimensional em apontar a malignidade desses processos neoplásicos. A amostra foi constituída por 114 cães com suspeita de processo neoplásico, e a observação compreendeu um período de 12 meses consecutivos. Em 88 desses animais, a presença de neoplasia abdominal foi confirmada. Em 84 (95,4%) cães, a origem da massa foi corretamente classificada, em 3 (3,5%) foi erroneamente classificada e em 1 (1,1%), a massa não foi identificada pelo exame sonográfico. Os tipos cito-histológicos diagnosticados no fígado foram: colangiocarcinoma 6(50%), carcinoma hepatocelular 3(25,1%), tumor de células mesenquimais?hemangiossarcoma 1(8,3%), linfoma de pequenas células 1(8,3%) e cistoadenoma de vias biliares 1(8,3%). No intestino foram identificados adenocarcinoma 2(25%), linfoma 2(25%), leiomiossarcoma 2(25%), tumor de células mesenquimais 1(12,5%) e adenoma de cólon 1(12,5%). No pâncreas foram diagnosticados: adenocarcinoma pancreático 3(75%) e insulinoma 1(25%). Com relação à diferenciação entre tumores hepáticos malignos e benignos pela ultra-sonografia convencional, 11 casos (100%) foram suspeitos de malignidade e confirmados com o padrão-ouro; contudo, parâmetros suspeitos para malignidade também foram observados em um caso de tumor benigno. Ao analisar a ultra-sonografia na suspeita de tumores nos segmentos intestinais para a diferenciação entre tumores e processo inflamatório, 8 (100%) casos suspeitos para processo neoplásico foram confirmados; todavia, parâmetros suspeitos para processos neoplásicos intestinais também foram observados em 3 casos de enterite inflamatória granulomatosa. Ao analisar a ultra-sonografia na suspeita de tumores pancreáticos exócrinos, foi possível identificar e localizar a massa em sua maioria, mas a diferenciação segura entre processo neoplásico e pancreatite crônica não foi possível. Conclui-se que: o exame sonográfico é um bom método de detecção da origem do processo neoplásico abdominal, e que embora não específicos, o achado sonográfico auxilia na determinação da malignidade do processo. / The purposes of the present study were to evaluate the diagnostic accuracy of ultrasonography in the assessment of abdominal organs due to neoplastic process, to determine the ultrasonographic findings of each tumor type found in the liver, intestines and pancreas, and thereby study the potential contribution of ultrasonography to distinguish benign from malignant lesions. One hundred and fourteen dogs with suspected neoplastic disease were enrolled in this prospective study during 12 consecutive months. 88 dogs were diagnosed as having abdominal neoplasm. In 84(95,4%) dogs the affected organ was correctedly identified, in 3(3,5%) dogs the affected organ was incorrectedly identified and in 1 dog the affected organ wasn?t identified. The tumors types in the liver were: cholangiocarcinoma 6(50%), hepatocellular carcinoma 3(25,1%), mesenchymal hepatic tumor ? hemangiosarcoma 1(8,3%), small cell lymphoma 1(8,3%) and bile duct cystadenoma 1(8,3%). Tumor types in the intestines were: adenocarcinoma 2(25%), lymphoma in alimentary tract 2(25%), leiomyosarcoma 2(25%), mesenchymal cell tumor 1 (12,5%) and colon adenoma 1 (12,5%). In the pancreas were: pancreatic adenocarcinoma 3(75%) and insulinoma 1(25%). Considering ultrasonographic findings alone we could predict malignant lesion in 11(100%) cases, and all cases had proven malignant liver neoplasm. However, one case of benign liver neoplasia was erroneuosly consireded as being malignant . Ultrasonographic findings alone were of important diagnostic value in differentiating intestinal neoplasia from enteritis. Eight (100%) dogs showing ultrasonographic signs of malignancy were confirmed as having malignant intestinal neoplasia, however, the same signs were seen in 3 cases of inflamatory granulomatous enteritis. Pancreatic masses were correctedly identified, but it was not possible to confidently differentiate between pancreatitis and pancreatic neoplasia. We conclude that use ultrasonography is of great value in determining the affected abdominal organ for neoplasic process, and that the sonography findings although not specific, may help in the assessment of malignancy.