A Síndrome Hipereosinofílica é uma desordem rara com prevalência estimada entre 0.36-6.3/100.000 habitantes, com seu diagnóstico através da contagem absoluta de eosinófilos superior a 1500 células/mm³ em duas medidas com intervalo mínimo entre elas de quatro semanas e/ou aumento no número de eosinófilos nos tecidos. Além disso, é preciso que haja lesão/disfunção orgânica associada e exclusão de causas potenciais de eosinofilia.Este é um caso de um paciente masculino, 49 anos, com um quadro de dispneia aos pequenos esforços, edema e dor em panturrilha direita, sem outras comorbidades prévias. Ao hemograma verificou-se a média de 30.021 eosinófilos, ultrassonografia de membros inferiores com trombose venosa em veia femoral direita, e tomografia torácica demonstrando trombo distal em artéria pulmonar direita. Apesar de essa síndrome ser rara, sempre deve-se estar atento para suspeitar do seu diagnóstico e trata-la rapidamente, evitando complicações letais.
Introduction: For the past few years, Nipple-Sparing Mastectomy (NSM) has been a tendency, and robotic breast surgery has become a reality. Until August, 2019, three robotic adenomastectmy procedures were carried out in Hospital Erasto Gaertner. The objective of this article is to demonstrate our results and publicize the knowledge in robotic surgery. Methods: Surgical Technique. The Da Vinci Surgical System Si® (Intuitive Surgical, Sunnyvale, CA) was used to perform the NSM surgeries. The 3 cm long incision was initiated in the axillary region, and the subcutaneous cellular tissue was resected to an area of 5 cm in diameter, to the portal. One mg/ml of adrenaline diluted in physiological serum 0.9% was infiltered in the subdermal breast tissue. Tunneling is executed with Metzenbaum scissors in the subdermal region. The device is coupled (GelPOINT Advanced Access Platformtm), and gas pressure of 8 mmHg is activated. The ProGrasp Forceps, the monopolar curved scissors and the 30º video camera are allocated in the robotic arms. The upper quadrants are superficially dissected, and then the lower quadrants, the retro-mammillary region and, finally, the breast muscle tissue. The expander is allocated between the chests with the open technique. Result: The duration of the mammary gland extirpation was 5 hours in the first unilateral adenomastectomy surgery, and 1 hour and 45 minutes in the last for the same type of surgery. In total, the first surgery took 6 hours and 20 minutes, which reduced to 3 hours in the last. In two surgeries we observed skin burns caused by electrocautery. These were solved in weeks, however, without the need for surgical intervention. We did not observe complications such as seroma, hematoma, loss of prosthesis, major pain, infection or subcutaneous emphysema due to carbon dioxide. Discussion: Complication rates are low, as shown by Lai et al. (2019), who analyzed a case series and showed transient nipple ischemia (10.3%) as the highest rate of complication; however, without nipple necrosis or loss of prosthesis. In the cases operated in Hospital Erasto Gaertner, the aesthetic results were very well evaluated both by the patients and the plastic surgery and mastology staff. Minor complications were solved in weeks, which maintained an excellent final outcome. The learning curve of the robotic technique was extremely fast, with considerable reduction in surgical time. Conclusion: We believe that innovative robotic surgery can contribute with the advancement of breast surgery around the world.
Introdução: O câncer de mama é a neoplasia que mais acomete mulheres no mundo, sendo uma a cada 10 mulheres que irão ser acometidas, no Brasil. Portanto, proporcionar cirurgias que tenham menor morbidade com as mesmas ou maiores taxas de cura é um desafio. De acordo com o exposto, até a década passada realizar linfadenectomia após quimioterapia neoadjuvante era mandatório, porém novos estudos estão conseguindo provar que para alguns casos a biópsia de linfonodo sentinela pode ser uma opção. Objetivo: Este estudo analisou o índice de positividade de linfadenectomias pós-quimioterapia neoadjuvante. Métodos: Foram avaliadas 152 pacientes, entre 2012 e 2014, que realizaram cirurgia de linfadenectomia, separado-as em dois braços, aquelas que eram axilas positivas clinicamente antes da quimioterapia em um braço, e no outro, axilas negativas antes do tratamento quimioterápico. Resultados: Desmembrando os 152 pacientes, 57 desses com axilas negativas anteriores à quimioterapia, obtivemos que 71% permaneceram negativas após linfadenectomia. No grupo de 95 pacientes com axilas positivas, após neoadjuvância quimioterápica, 43,6% resultaram estarem livres de comprometimento neoplásico após linfadenectomia . Discussão: Os resultados denotados no índice de positividade de linfonodos em todos os grupos foram muito semelhantes à literatura mundial, demonstrando que nosso estadiamento antes da quimioterapia e nosso tratamento neoadjuvante são realizados com a mesma eficácia do que de outros hospitais já estudados. Também pudemos denotar que estamos autorizados a realizar biópsia de linfonodo sentinela pós-quimioterapia naquelas pacientes as quais eram negativas as axilas clinicamente, antes do tratamento neoadjuvante. Conclusão: A biópsia de linfonodo sentinela é uma técnica segura e eficaz em pacientes pós-quimioterapia com axilas negativas e devemos sempre incentivar essa técnica, quando for indicado.PALAVRAS-CHAVE: câncer de mama; linfonodo sentinela; diagnóstico. RESUMO ABSTRACTIntroduction: Breast cancer is the most prevalent tumor in women around the world, affecting 1 in 10 women in Brazil. Therefore, providing surgeries that can increase cure rates and provide less comorbidities than those that occur today is a challenge. Until the last decade, performing lymphadenectomy, after neoadjuvant therapy was mandatory. However, new studies could prove that, for some cases, the sentinel lymph node biopsy can be an option. Objective: To analyze the positivity rates of lymphadenectomy, after neoadjuvant therapy. Methods: A total of 152 patients who underwent lymphadenectomy were assessed, from 2012 to 2014; they were separated into two groups of arms: those that had clinically positive armpit results before chemotherapy in one arm, and those that had negative armpit results before chemotherapy. Results: Out of 152 patients, 57 had negative armpit results before chemotherapy, 71% continued to have negative results following lymphadenectomy. In the group containing 95 patients with positive armpit results (following neoadjuvant thera...
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