ResumoContextoA insuficiência venosa crônica (IVCr) é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina.ObjetivosIdentificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs) e parvas (VSPs) em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP).MétodosForam avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV) com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois.ResultadosNos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%). Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%). Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%), e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%). Refluxo na junção safeno-femoral (JSF) foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6.ConclusõesO padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.
Background: the use of nipple-sparing mastectomy (NSM) in local advanced breast cancer after neoadjuvant chemotherapy (NQT) is increasing, despite few studies on the subject. The aim of this systematic review was to determine the safety of NSM after neoadjuvant chemotherapy. Methods: for this systematic review we searched MEDLINE; Cochrane; Scientific Electronic Library Online (SciELO); Embase and Scopus. A literature search of all original studies including randomized controlled trials, cohort studies and case-control studies comparing women undergoing NSM after neoadjuvant chemotherapy for breast cancer was undertaken. Outcomes were locoregional recurrence (LRR), nipple recurrence and distant recurrence (DR). Data analysis was undertaken to explore the safety of NSM after NQT. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021276778. Findings: a total of 437 articles were identified. Four articles were included with 1466 patients all of which had a high to serious risk of overall bias. Local recurrence in the NSM after the NQT group ranged from zero to 9.8%. Nippleareolar complex (NAC) recurrence ranged from zero to 2.1%. The distant recurrence rate ranged from 6.5% to 16%. Due to the lack of pattern among the control groups, it was not possible to perform a meta-analysis. Interpretation: this review provides information for decision making in performing NSM after NQT. Despite the low rates of local recurrence and patients should be counseled about limited oncological information.
Introduction: Achieving a pCR after neoadjuvant chemotherapy is generally associated with better outcomes. Identifying modifiable and non-modifiable variables that correlate with a complete response is important to treatment. Objectives: The aim of this study was to identify clinical and immunohistochemical variables that correlate with pCR, in a public and a private breast cancer unit in the city of Curitiba, state of Paraná, Brazil. Methods: A retrospective analysis was carried out through medical records at Hospital de Clínicas- UFPR and Centro de Doenças da Mama- Hospital Nossa Senhora das Graças. Patients who underwent surgical treatment after neoadjuvant chemotherapy, in the period from January 1, 2017 to December 31, 2020, due to an invasive ductal carcinoma were selected. Clinical and immunohistochemical variables were correlated to the presence of pCR. Ethical committee approval n. 4,295,049. Results: In 240 cases included, 66 (27.5%) reached pCR. There was a significant correlation between pCR and the negativity of the hormonal receptors (p=0.002), HER2 positivity (p=0.002), Ki67 expression (p=0.012) and molecular subtypes (p=0.001). A ROC (receiver operating characteristic) curve analysis identified a 50% percentage as the best cut-off value to predict complete response. On the other hand, it was not observed a significant correlation between pCR and body mass index, or physical activity. Conclusions: There is a strong correlation between immunohistochemical parameters and pCR. Further studies are needed to determine the correlation between modifiable variables.
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