Aufgrund der verfügbaren Literatur und Daten ist nicht erwiesen, dass eine prophylaktische Thrombozytentransfusion nach myeloablativer Chemotherapie notwendig oder für den Patienten vorteilhaft ist. Die im Verlauf der Jahre immer weiter gesenkten Schwellenwerte zur prophylaktischen Thrombozytentransfusion legten nahe, die Möglichkeit zu überprüfen, auf eine prophylaktische Substitution ganz zu verzichten und nur im Falle relevanter Blutungen zu transfundieren. Mit der hier ausgewerteten Studie liegen erstmals Daten aus einer multizentrischen, prospektiv randomisierten Studie zum Vergleich einer prophylaktischen mit einer therapeutischen Transfusionsstrategie für Thrombozyten nach autologer Stammzelltransplantation vor: es wurde eine prophylaktische Thrombozytentransfusion bei Thrombozytenwerten ≤ 10/nl mit einer neuen Transfusionsstrategie (Substitution nur bei relevanter Blutung oder definierten Risikosituationen) verglichen. Mit der experimentellen, therapeutischen Transfusionsstrategie für Thrombozyten kann eine Reduktion der Thrombozytentransfusionen um ca. 50% im Vergleich zu dem etablierten prophylaktischen Transfusionsregime erreicht werden: bei den hier untersuchten 92 Patienten wurden im experimentellen Arm für 47 Patienten nur 37 Thrombozytenkonzentrate benötigt, für die 45 prophylaktisch behandelten Patienten wurden insgesamt 71 Thrombozytenkonzentrate verbraucht. Die experimentelle therapeutische Transfusionsstrategie für Thrombozyten führte zu keiner statistisch signifikanten Zunahme von Blutungskomplikationen; auch bei der Anzahl der benötigten Erythrozytentransfusionen gab es keine signifikanten Unterschiede; Nebenwirkungen der Transfusionen, Dauer der Thrombopenie und Anzahl der Tage im Krankenhaus waren ebenso nicht signifikant unterschiedlich. Das Risiko, während der Beobachtungszeit (Chemotherapie und autologe Stammzelltransplantation bis zur Regeneration der Thrombozytenwerte), eine Blutung zu erleiden, lag insgesamt bei 14.1%; im experimentellen Arm lag das Risiko bei 19.2%, bei den prophylaktisch substituierten Patienten bei 8.9%; dieser Unterschied war statistisch nicht signifikant, ohnehin traten bei den beobachteten Patienten nur milde, klinisch wenig bedeutsame Blutungen des WHO – Schweregrades < 3 auf, es kam zu keinen blutungsassoziierten Todesfällen Bei klinisch stabilen Patienten und sorgfältiger Überwachung ist ein therapeutisches Transfusionsregime für Thrombozyten nach autologer Stammzelltransplantation praktikabel und sicher anwendbar, die Sicherheit dieses Vorgehens bei Patienten nach autologer Stammzelltransplantation wird mit der vorliegenden randomisierten Studie belegt. Eine therapeutische Thrombozytentransfusionsstrategie ist vermutlich bei einer Vielzahl weiterer hämato-onkologischer Patienten bzw. Krankheitsbilder ausreichend und kann unter signifikanter Einsparung kostbarer Thrombozytenkonzentrate bedrohliche Blutungen ebenso aufhalten oder verhindern wie ein prophylaktisches Regime.

The state of global health and wellbeing is threatened by the pervasive and dangerous decision to engage in unprotected sex. Only male or female condoms can prevent the spread of both sexually transmitted infections and unintended pregnancies. Despite this, condoms remain dangerously underused because of the perception that they diminish sexual pleasure. The pleasure gap in the design and promotion of condoms cripples sexual health outcomes. Acknowledging and harnessing the power of pleasure in sexual-decision making is key to increasing condom use.

Papilomavírus humanos (HPVs) são vírus de DNA que infectam células epiteliais, podendo ser responsáveis pelo aparecimento de lesões benignas e malignas. Dentre os mais de 120 tipos identificados, o HPV -16 constitui o principal agente etiológico do câncer cervical, que é uma das maiores causas de morte por câncer em mulheres no mundo. Sendo assim, infecções associadas ao HPV devem ser prevenidas por vacinas indutoras de resposta imune vírus-específicas. A proteína L1 do capsídio viral é capaz de arranjar-se em partículas morfologicamente e antigenicamente semelhantes ao vírus, denominadas \"virus-like particles\" (VLPs), que induzem altos títulos de anticorpos neutralizantes. Neste trabalho, foram clonados os genes L1 selvagem e otimizado de HPV -16 em vetores de expressão de leveduras metilotróficas como Hansenula polymorpha e Pichia pastoris. Foi observada uma expressão consistente da proteína recombinante apenas em P. pastoris, com o gene L1 otimizado. Foram realizadas diversas tentativas de purificação da proteína heteróloga, empregando técnicas de cromatografia e ultracentrifugação em gradiente descontínuo de sacarose. A correta montagem das VLPs foi confirmada por microscopia eletrônica. Problemas de agregação, heterogeneidade e adsorção a superfícies apresentados pela proteína L1 foram resolvidos após utilização de surfactante não-iônico e de um procedimento de desmontagem e remontagem das partículas, gerando preparações mais homogêneas. Ensaios de hemaglutinação e inibição da hemaglutinação comprovaram a apresentação de epítopos conformacionais na superfície das VLPs. Este trabalho demonstrou pela primeira vez a expressão da proteína L1 de HPV -16 em P. pastoris, visando ao desenvolvimento de uma vacina profilática de baixo custo para o sistema público de saúde. / Human papillomaviruses (HPVs) are DNA viruses that infect epithelial cells and can cause both benign and malignant lesions. From over 120 types catalogued so far, HPV-16 is the main etiologic agent of cervical cancer, which is the one of the most common causes of cancer deaths among women worldwide. Thus, HPV -associated infections might be prevented by vaccine inducing virus-specific immune responses. The L1 major capsid protein can self assemble into virus-like particles (VLPs), which are morphologically and antigenically indistinguishable from native viruses and induce high titers of neutralizing antibodies. In this work, we have cloned wild-type and codon-optimized L1 genes from HPV-16 in expression vectors of the methylotrophic yeasts Hansenula polymorpha and Pichia pastoris. Consistent L1 expression was only observed in P. pastoris transformed with the construction containing the codon-optimized gene. Many attempts to purify the heterologous protein were made, including chromatography and ultracentrifugation in sucrose density gradients. The correct assembly of VLPs was confirmed by electron microscopy. Some problems presented by recombinant L1 like aggregation, surface adsorption and heterogeneity were solved by using non-ionic surfactants and a procedure of disassembly and reassembly of the particles. Hemagglutination and hemagglutination inhibition assays corroborated the display of surface conformational epitopes by VLPs. This work showed for the first time the expression of the HPV-16 L1 protein in P. pastoris, aiming the development of a prophylactic vaccine free of charge for the public health system in Brazil.

Ursache des klinisch durch die Amsterdam-Kriterien definierten HNPCC sind hochpenetrante Keimbahnmutationen in den DNAMismatchrepair( MMR)-Genen MLH1, MSH2, seltener in MSH6 und PMS2. Mutationsträger in diesen MMR-Genen haben ein hohes kumulatives Risiko (52–92%) für die Entwicklung kolorektaler – einschließlich syn- und metachroner – Karzinome, die sich meist in früheren Lebensjahren als bei sporadischen Fällen entwickeln. Darüber hinaus findet sich bei diesen Mutationsträgern ein deutlich erhöhtes Risiko für extrakolonische Karzinome, insbesondere des Endometriums, seltener der Ovarien, des Magens, der ableitenden Harnwege und des Dünndarms. Aus dieser Risikokonstellation erwächst die Frage nach einem spezifischen, individualisierten Therapiekonzept bei HNPCC-Patienten bzw. Mutationsträgern. Prinzipiell könnten drei Möglichkeiten des chirurgischen Vorgehens bezüglich des Kolorektums in Frage kommen: 1. prophylaktische Resektion bei gesunden Mutationsträgern 2. onkologische Resektion bei Karzinommanifestation 3. erweiterte Resektion mit zusätzlich prophylaktischer Intention bei Manifestation des ersten Kolon- oder Rektumkarzinoms. Die erste Möglichkeit kann nach kritischer Evaluation verschiedener Argumente als Option der Prävention nicht empfohlen werden. Zur Zeit kann sicherlich auch keine endgültige Empfehlung abgegeben werden, ob die zweite oder dritte Option des operativen Vorgehens favorisiert werden sollte. Die Indikation zur prophylaktischen Hysterektomie und Oophorektomie sollte nach ausführlicher genetischer, chirurgischer und gynäkologischer Beratung bei postmenopausalen Patientinnen, die die Amsterdam-Kriterien erfüllen oder Trägerinnen einer pathogenen Keimbahnmutation in einem MMR-Gen sind und bei denen dieser Eingriff mit einer anderweitig indizierten Operation kombiniert werden kann, erwogen werden. Eine exakte Prädiktion des individuellen Risikos und Erkrankungsalters auf Grundlage der Analyse von Interaktionen zwischen endogenen und exogenen, modifizierenden Faktoren ist Voraussetzung für individuelle Empfehlungen für «maßgeschneiderte»Vorsorgeprogramme oder prophylaktische chirurgische Maßnahmen. / Hereditary nonpolyposis colorectal cancer (HNPCC), clinically defined by the Amsterdam criteria, is caused by highly penetrant germ line mutations in DNA mismatch repair (MMR) genes, mostly in MLH1 and MSH2, infrequently in MSH6 und PMS2. Mutation carriers are at high cumulative risk (52-92%) for developing colorectal cancer (CRC), including syn- and metachronous colorectal carcinomas, with a younger age of onset compared with sporadic CRC. In addition, there is a remarkably increased risk in these mutation carriers for extracolonic carcinomas, especially for endometrial and ovarian carcinomas but also for gastric, ureter and renal pelvis and small bowel cancer. Therefore, the question arises if an individually tailored conception of treatment should be applied to HNPCC patients and mutation carriers. On principle, there are three options of surgical approach conceivable concerning the colorectum: i) prophylactic resection in healthy mutation carriers ii) oncological resection in the case of CRC iii) extended resection with an additional prophylactic intent in the case of first CRC. After critical evaluation of various arguments, the first option cannot be recommended for CRC prevention. However, a final recommendation neither for the second nor the third option of surgical approach can be given at the moment. The indication for a prophylactic hysterectomy and oophorectomy should be weighted in the following postmenopausal patients after intensive genetic, surgical and gynecologic counselling: patients fulfilling the Amsterdam II criteria or who have been identified as mutation carriers of a disease causing germ line mutation in one of the MMR genes and who have to be operated on due to another cause. A precise prediction of the individual risk and age of onset on the basis of the analysis of interactions between endogenous and exogenous modifying factors is the precondition for recommendations concerning individually tailored surveillance or prophylactic surgery. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Bakgrund: Bröstcancer är den vanligaste cancerdiagnosen och mutation av BRCA 1/2-gener ökar bröstcancerrisken. Drabbade kvinnor får information kring behandlingsstrategier vilka diskuteras med eventuella närstående samt vårdpersonal och grundlägger val av behandling. Kvinnors upplevelser av profylaktisk mastektomi påverkas av flera aspekter, och påvisar därmed vikten av sjuksköterskans kompetens inom omvårdnad. Syfte: Att sammanställa och syntetisera kvalitativ forskning som utforskat vad som påverkar kvinnors beslutsfattande vid profylaktisk mastektomi vid risk för bröstcancer eller vid befintlig ensidig bröstcancer. Metod: En litteraturöversikt med kvalitativ ansats utifrån 13 originalartiklar vilka analyserades med tematisk innehållsanalys. Resultat: Tre teman identifierades; ”Existentiella val”, ”Informationens betydelse” samt ”Kroppslig påverkan”. Temat ”Existentiella val” gav två subteman, ”Mastektomi som oroslindrande” samt ”Minska risk för (åter)insjuknande”. Ur temat ”Informationens betydelse” identifierades två subteman, ”Informationsbehov” samt ”Omgivningens erfarenheter/åsikter” och temat ”Kroppslig påverkan” resulterade i subtemana ”Synen på kropp och kvinnlighet” och ”Amning”.  Slutsats: Litteraturstudien påvisar kvinnors beslutsfattande avseende profylaktisk mastektomi såsom rädslor, otillräckligt anpassad information samt kroppsliga aspekter. Resultatet påvisar ett behov av vidare forskning avseende dessa kvinnors upplevelser för att ge en djupare förståelse och ökad kompetens inom vården för att möjliggöra en personcentrerad och holistisk vård. / Background: Breast cancer is the most common cancer diagnosis, and BRCA 1/2 gene mutations increases breast cancer risk. Affected women receive information about treatment strategies, which are discussed with relatives and healthcare professionals and lay the foundation for treatment choices. Women´s experiences of prophylactic mastectomy are affected by many aspects, highlighting the importance of nursing competence.  Aim: To synthesize qualitative research exploring aspects affecting women´s decision-making regarding prophylactic mastectomy in case of increased breast cancer risk or existing unilateral breast cancer.    Method: A literature review with a qualitative approach based on 13 original articles, analyzed using thematic content analysis.   Result: Three themes were identified; “Existential choices”, “The importance of information” and “Physical impact”. “Existential choices” resulted in the subthemes, “Mastectomy as anxiety reliever” and “Reducing the risk of (re)occurrence”. “The importance of information” presented the subthemes “Informational needs” and “The experiences/opinions of others”. “Physical impact” offered subthemes “View of body and femininity” and “Breastfeeding”.   Conclusion: Aspects influencing women's decision-making regarding prophylactic mastectomy were revealed, e.g. fears, information and physical aspects. The results indicate a need for further research to deepen understanding and enhance healthcare competence for person-centered and holistic care.

Résumé Introduction L’efficacité de la mastectomie prophylactique est bien démontrée. La mastectomie NSM (nipple-sparing mastectomy) peut potentiellement améliorer les résultats esthétiques, mais elle n’est pas pratiquée d’emblée en raison de doutes face à sa sécurité oncologique. Objectif Évaluer la faisabilité et la sécurité oncologique de la NSM dans un contexte prophylactique ainsi que les résultats esthétiques et la satisfaction des patientes. Méthodologie Une étude rétrospective fut conduite chez toutes les femmes ayant subi une mastectomie prophylactique suivie d’une reconstruction mammaire immédiate au centre hospitalier de l’Université de Montréal (CHUM) entre1997 et 2008. Les données concernant les facteurs de risque de cancer, les complications post-opératoires et les incidences de cancer furent notées. La satisfaction des patientes était évaluée par questionnaire. Deux chirurgiens ont évalué les résultats esthétiques sur des photos. Résultats Soixante et onze patientes ont subi 86 mastectomies prophylactiques, dont 21 NSM et 65 SSM (skin-sparing mastectomy). Suivant une SSM, 34 CAM (complexe aréolo- mamelonaire) furent reconstruits. Une nécrose totale s’est produite dans 2 CAM préservés et dans 2 CAM reconstruits. Le taux général de complications était significativement plus élevé parmi les CAM reconstruits. La satisfaction des patientes quant à l’apparence du CAM était significativement plus élevée dans le groupe NSM et les résultats esthétiques, meilleurs. Avec un temps de suivi moyen de 50 mois, aucune incidence au niveau du CAM n’est survenue. i Conclusion Les NSM offrent de meilleures résultats, n’augmentent pas les complications post- opératoire et semblent sécuritaires au plan oncologique. / Introduction The efficiency of prophylactic mastectomy is well acknowledged. Nipple sparing mastectomy (NSM) can potentially improve cosmetic results, but it is not the current practice because of doubts regarding its oncological safety. Objectives To evaluate NSM’s feasibility and oncological safety in a prophylactic setting, as well as aesthetic results and patient satisfaction. Methods A retrospective study was conducted on every women that underwent prophylacitc mastectomy followed by immediate breast reconstruction in the centre hospitalier de l’Université de Montréal (CHUM) between 1997 and 2008. Data regarding cancer risk factors, post operative complication and cancer incidence were compiled. Patient satisfaction was evaluated using a questionnaire and two plastic surgeons rated the aesthetic results on photos. Results Seventy-one patients underwent 21 NSM et 65 skin-sparing mastectomies (SSM) for a total of 86 prophylactic procedures. Following SSM, 34 nipple areolar-complexes (NAC) were reconstructed. Necrosis was noted in 2 preserved NAC and in 2 reconstructed NAC. The overall complication rate was superior among the reconstructed NAC. Patient satisfaction regarding NAC appearance was significantly higher within the preserved NAC group and the aesthetic results were evaluated as better. With a mean follow-up time of 50 months, no incidence was noted in the NAC area. iii Conclusion NSM offer superior aesthetic results, do not increase post-operative complications and appear the be oncologicaly safe.

O câncer de colo do útero é a segunda principal causa de morte em mulheres por câncer, sendo causado principalmente pela infecção persistente por HPV. A principal forma atual de prevenção desse câncer é a realização de exames citológicos periódicos e a vacinação profilática disponibilizada recentemente pelo Ministério da Saúde. Entretanto, tais ações visam a prevenção da infecção por HPV ou a detecção de lesões, pois não há um tratamento específico contra infecções e lesões já estabelecidas. Dentre as proteínas expressas por HPV, L2 está presente no capsídeo viral e é bem conservada entre diversos tipos de HPV, enquanto E6 é uma proteína oncogênica capaz de induzir a transformação maligna das células. Este estudo visa o desenvolvimento de uma vacina profilática e terapêutica capaz de proteger contra a infecção por diversos tipos virais, assim como combater as células já modificadas por qualquer tipo de HPV. Assim, foi construído um vetor vacinal contendo peptídeos selecionados das proteínas L2 e E6 de HPV16 testadas em modelo murino, para avaliar sua eficiência como vacina de DNA ministrada antes ou após desafio com células tumorais. Os ensaios em modelo animal demonstraram que a vacina foi capaz de induzir a produção de anticorpos específicos anti-L2 e anti-E6, assim como induzir a produção de citocinas TNF e impedir o desenvolvimento tumoral de células HPV-positivas. Portanto, foi possível concluir que o vetor construído foi capaz de induzir uma resposta imune humoral e celular em camundongos, capaz de prevenir contra o HPV, assim como tratar os cânceres a ele associados. / Cervical cancer is the second most frequent cause of death in women due to cancer, mainly caused by persistent HPV infection. The primary prevention method of this cancer is through periodic cytological exams and prophylactic vaccination which has been recently made available by the Ministry of Health. However, such actions aim towards prevention of HPV infection or the detection of lesions, since there is no specific treatment against pre-existing infections and injuries. Among the proteins expressed by HPV, L2 is present in the viral capsid and is well conserved among several types of HPV, whereas E6 is an oncogenic protein, capable of inducing malignant mutations in cells. This study aims towards the development of a prophylactic and therapeutic vaccine, capable of protecting against infections caused by several viral types, as well as combating cells which have already been modified by any type of HPV. Thus, a vaccine vector, containing peptides selected from HPV16s L2 and E6 proteins, tested in the murine model, was constructed in order to evaluate its efficiency as a DNA vaccine, to be administered either before or after challenging with tumour cells. The animal model assays demonstrated that the vaccine was able to induce the production of anti-L2 and anti-E6 specific antibodies, as well as TNF cytokines, and to prevent tumour development in HPV-positive cells. Therefore, it was possible to conclude that the designed vector was indeed able to induce humoral and cellular immune responses in mice, capable of preventing against HPV, as well as of treating cancers associated with it.

Made available in DSpace on 2015-09-25T12:23:10Z (GMT). No. of bitstreams: 1 TaniaDeSouzaFarias.pdf: 409062 bytes, checksum: 154f204aa9cc212ec7064f63209a81ee (MD5) Previous issue date: 2007-02-28 / The discovery of antimicrobials provided a significant reduction in infections and promoted a significant improvement in the population s quality of life. However, this reality provoked an inadequate use of these medicines, and consequently, the appearance of lineages of bacteria resistant to the action of antibiotics. Clinical usage of antimicrobials in hospitals brings individual and collective consequences because it affects the individual who uses this pharmaceutical and the microbiology of the hospital atmosphere. Thus, the main objective was to get to know the patterns of antimicrobial usage in the public hospital. A transversal study was performed, in which all prescriptions of the patients in the different clinics of the hospital who used an antimicrobial agent during internment were analyzed. Therapeutic use of antimicrobials represented 89% of the cases studied in pediatrics. Prophylactic usage occurred in all of the maternity and surgery cases, and in 81% of the clinical oncology cases. Antimicrobial consumption was primarily prophylactic, being first generation cephalosporin the most prescribed pharmaceutical. Therapeutic usage occurred principally in pediatrics and the most prescribed medications were penicillin, gentamicine and chloramphenicol. Empiric therapeutics was predominant. Inadequate use of chloramphenicol and the need for controlling measures in the usage of antimicrobials were observed in the different clinics. / A descoberta dos antimicrobianos proporcionou a redução significativa das infecções e promoveu uma melhora significativa na qualidade de vida da população. Entretanto, essa realidade ocasionou o uso inadequado desses medicamentos e conseqüentemente o surgimento de cepas de bactérias resistentes à ação dos antibióticos. O uso clínico de antimicrobianos em hospitais tem conseqüências individuais e coletivas, pois afeta o indivíduo que faz uso desse fármaco, e a microbiota do ambiente hospitalar. Desse modo, o objetivo desse trabalho foi conhecer os padrões de uso de antimicrobianos em um hospital público. Realizou-se um estudo transversal, no qual foram analisadas todas as prescrições dos pacientes das diferentes clínicas do hospital que fizeram uso algum agente antimicrobiano durante a internação. O uso terapêutico de antimicrobianos representou 89% dos casos estudados na pediatria. O uso profilático ocorreu em todos os casos da maternidade e da Ala cirúrgica, e em 81% da clínica oncológica. O consumo de antimicrobianos foi principalmente profilático sendo as cefalosporinas de primeira geração os fármacos mais prescritos. O uso terapêutico ocorreu principalmente na pediatria e os fármacos mais prescritos foram penicilinas, gentamicina e cloranfenicol. A terapêutica empírica foi predominante. Observou-se o uso inadequado de cloranfenicol nas diferentes clínicas e a necessidade de medidas de controle do uso de antimicrobianos.

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.

Résumé Introduction L’efficacité de la mastectomie prophylactique est bien démontrée. La mastectomie NSM (nipple-sparing mastectomy) peut potentiellement améliorer les résultats esthétiques, mais elle n’est pas pratiquée d’emblée en raison de doutes face à sa sécurité oncologique. Objectif Évaluer la faisabilité et la sécurité oncologique de la NSM dans un contexte prophylactique ainsi que les résultats esthétiques et la satisfaction des patientes. Méthodologie Une étude rétrospective fut conduite chez toutes les femmes ayant subi une mastectomie prophylactique suivie d’une reconstruction mammaire immédiate au centre hospitalier de l’Université de Montréal (CHUM) entre1997 et 2008. Les données concernant les facteurs de risque de cancer, les complications post-opératoires et les incidences de cancer furent notées. La satisfaction des patientes était évaluée par questionnaire. Deux chirurgiens ont évalué les résultats esthétiques sur des photos. Résultats Soixante et onze patientes ont subi 86 mastectomies prophylactiques, dont 21 NSM et 65 SSM (skin-sparing mastectomy). Suivant une SSM, 34 CAM (complexe aréolo- mamelonaire) furent reconstruits. Une nécrose totale s’est produite dans 2 CAM préservés et dans 2 CAM reconstruits. Le taux général de complications était significativement plus élevé parmi les CAM reconstruits. La satisfaction des patientes quant à l’apparence du CAM était significativement plus élevée dans le groupe NSM et les résultats esthétiques, meilleurs. Avec un temps de suivi moyen de 50 mois, aucune incidence au niveau du CAM n’est survenue. i Conclusion Les NSM offrent de meilleures résultats, n’augmentent pas les complications post- opératoire et semblent sécuritaires au plan oncologique. / Introduction The efficiency of prophylactic mastectomy is well acknowledged. Nipple sparing mastectomy (NSM) can potentially improve cosmetic results, but it is not the current practice because of doubts regarding its oncological safety. Objectives To evaluate NSM’s feasibility and oncological safety in a prophylactic setting, as well as aesthetic results and patient satisfaction. Methods A retrospective study was conducted on every women that underwent prophylacitc mastectomy followed by immediate breast reconstruction in the centre hospitalier de l’Université de Montréal (CHUM) between 1997 and 2008. Data regarding cancer risk factors, post operative complication and cancer incidence were compiled. Patient satisfaction was evaluated using a questionnaire and two plastic surgeons rated the aesthetic results on photos. Results Seventy-one patients underwent 21 NSM et 65 skin-sparing mastectomies (SSM) for a total of 86 prophylactic procedures. Following SSM, 34 nipple areolar-complexes (NAC) were reconstructed. Necrosis was noted in 2 preserved NAC and in 2 reconstructed NAC. The overall complication rate was superior among the reconstructed NAC. Patient satisfaction regarding NAC appearance was significantly higher within the preserved NAC group and the aesthetic results were evaluated as better. With a mean follow-up time of 50 months, no incidence was noted in the NAC area. iii Conclusion NSM offer superior aesthetic results, do not increase post-operative complications and appear the be oncologicaly safe.