Radioterapia intraoperatoria de electrones en cáncer de mama. Experiencia en Venezuela.

Objective: To evaluate the evolution of patients treated with intraoperative electron radiotherapy by Group J Soteldo, in Hospital de Clínicas Caracas. Methods: Descriptive observational study. We included 18 patients treated with intraoperative electron radiation therapy between April 2017 and July 2018. Medical records were reviewed to study the evolution, patients who had not returned in the last six months were contacted by telephone. Intraoperative electron radiation therapy was applied during the same surgical act, at a dose of 21 Gy, after the tumor was removed from the affected breast, at the level of the tumor bed. Results: The mean age was 54.5 years, the mean tumor size was 2.48 cm. Twelve patients had cancer in the right breast (66.7%) and six in the left (33.3%). Nine cases (50%) were Luminal B; 15 patients had infiltrating ductal carcinoma (83.3%), 13 (72.2%) had a negative axilla. Six patients (33.3%) underwent axillary dissection up to the third level and 12 (66.7%) had a sentinel node. Five patients (27.8%) received a single dose of intraoperative electron radiation therapy and 13 (72.2%) received booster doses. No patient has had a relapse of the disease or serious adverse effects associated with radiation therapy. Conclusion: The use of intraoperative electron radiation therapy was an effective and well tolerated treatment in this group of patients. It is not a commonly used treatment in Venezuela. Key words: Breast cancer, Radiotherapy, Electrons.

Tubercular Mastitis in an Elderly Female: A Rare Entity

Introduction: Tuberculosis of the breast is a rare entity, especially in elderly females. Moreover, the disease is overlooked and misdiagnosed as malignancy or pyogenic abscess. Here we report a case of an elderly female who presented with a lump in her left breast which resembled malignancy. Fine needle aspiration cytology followed by histopathological examination confirmed the diagnosis of breast tuberculosis. Patient underwent excision of the lump followed by six months of anti tubercular therapy to which she responded well. Key words: breast; mastitis; tuberculosis

The Effect of Breast and Bottle Feeding on Dental Caries in Preschool Children

Introduction: This study evaluates the effect of breast and bottle feeding on the severity and age of onset of early childhood caries (ECC). This prospective study conducted at the dental clinic of King Hussein Medical Center between March 2020 and July 2020. All preschool children who attended to the dental clinic suffering from dental caries were included in the study. Methodology: All preschool children who attended to the dental clinic suffering from dental caries were included in the study. A detailed history was obtained regarding age, gender, medical diseases, dental history, duration, frequency, and patterns of infant feeding. The patients were divided into 3 groups; the 1st group are those with exclusive breast feeding, the 2nd group are those with excusive bottle feeding and the 3rd group are those with mixed bottle and breast feeding. The age of onset of the caries was recorded. The severity of dental caries using DMFT index was explored in the groups. The obtained data was analyzed and compared with other studies. Results: 240 patients with aged between 3 and 6 years (mean 4.6±1.1) were enrolled in the study. A bout 55% of them was males. The commonest method of feeding for children was combined breast and bottle feeding (43%) followed by exclusive breast feeding (34%) and bottle feeding (23%). The highest DMFT score was found among patients with bottle feeding (4.9). The highest DMFT scores and earlier onset of caries were observed among patients who were breast fed (5.2, 3.2) or bottle fed (4.8,3.1) for more than 2 years respectively. Patients who were fed at night or those with frequent daily feeding at a rate of more than 6 times were associated with more sever forms of dental caries. Conclusion: Bottle feeding, nocturnal feeding and prolonged and frequent breast feeding were associated with more sever forms and earlier onset of dental caries in preschool children. Therefore, exclusive daily breast feeding at a rate not exceeding 6 times daily and for a duration not exceeding 12 months is recommended as a habit of feeding for infants. Key words: Breast feeding, Bottle feeding, Dental caries

Imaging features of primary breast sarcoma: a case report

Primary breast sarcomas (PBS) are a rare group of non-epithelial tumors arising from connective tissue of breast. This is a case of 55 year old female who presented with rapidly increasing left breast mass, mammogram showed a large high density mass occupying whole of left breast, Doppler ultrasound showed increased vascularity mass, diagnosis was confirmed by histopathology of ultrasound guided biopsy. Although there are no pathognomonic imaging features of PBS, however, presence of a solitary large mass showing rapid growth, with circumscribed or indistinct margins without axillary lymph node involvement should raise the suspicion of sarcoma and prompt biopsy to ensure early diagnosis and treatment; particularly considering the aggressive nature of these sarcomas. Key words: Breast, Computerized Tomography, Mammography, Sarcoma, Ultrasonography Continuous...

Relato de experiência das enfermeiras do Banco de Leite Humano da Santa Casa de Misericórdia de São Paulo, voltado às práticas de promoção, proteção e apoio ao aleitamento materno / Experience report from the nurses of the Human Milk Bank of Santa Casa de Misericórdia de São Paulo, focused on practices of promotion, protection and support to breastfeeding

Objetivo: Relatar a experiência das enfermeiras do banco de leite humano (BLH) da Santa Casa de Misericórdia de São Paulo, demonstrar as novas atribuições, descrever as repercussões destas mudanças e avaliar o volume de leite coletado. Método: Estudo transversal, descritivo e analítico. Os dados foram coletados dos arquivos de registros do BLH desta instituição, de 2016 a 2018. Resultado: Após início de um projeto com atividades educativas voltadas à divulgação da atuação do BLH, observamos o aumento do número de doadoras de leite materno e, consequentemente, melhoria no fornecimento de leite humano pasteurizado aos prematuros internados. No ano de 2016 os atendimentos somaram 2821 mães, e em 2018, 3238 (demonstrando um aumento de 15% no período). No tocante ao volume de leite coletado, foram 278,65 litros em 2016, contra 370,91 litros em 2018; demonstrando um aumento de 33%. Conclusão: As ações de acolhimento, marketing, socialização e busca ativa realizadas favoreceram o aumento do número de doadoras de leite materno e no volume de leite coletado, bem como sua fidelização. A ampliação das atividades levou a um importante espaço de atuação do enfermeiro que trabalha no BLH. Palavras-chave: Aleitamento materno, Banco de leite, Enfermagem obstétricaABSTRACT Objective: To report an experience lived by the nurses of the human milk bank (HMB) of Santa Casa de Misericórdia de São Paulo, demonstrate the new attributions, describe the repercussions of these changes and evaluate the amount of appointments and milk volume collected from 2016 to 2018. Method: It was a cross-sectional descriptive and analytical study. Results: After beginning a project with educational activities aimed disseminating the HMB, culminating in the increase in the number of breast milk donors and, consequently, in the milk provision (more regular) for hospitalized premature newborns. The total number of attendances jumped from 2821 in 2016 to 3238 in 2018 (an increase of 15%). Regarding the volume of collected milk, we got 278,65 liters in 2016 against 370,91 liters in 2018 (an increase of 33 %). Conclusion: The actions of reception, marketing, socialization and the active search performed favored an increase in the number of breast milk donors and in the volume of collected milk, and to keep their loyalty. The expansion of these activities led to an important new field of nurses activities on the HMB. Key words: Breast feeding, Milk banks, obstetric nursing

Breastfeeding support at an Australian Breastfeeding Association drop-in service: a descriptive survey

Background: In Australia, during the early establishment phase of breastfeeding, women can access telephone peer support counselling provided by the Australian Breastfeeding Association (ABA) however options for face-to-face peer support are limited. The known factors which improve ongoing and exclusive breastfeeding include face-to-face support, peer and/or professional support, and trained personnel. This study aimed to examine women’s experiences of accessing one breastfeeding drop-in peer support service provided by trained peer support volunteer counsellors from the ABA.Methods: Women who accessed the service were invited, in 2014, to participate in an anonymous online survey which collected both quantitative and qualitative data. Participants were asked about their experiences of breastfeeding support, as well as their experiences of the drop-in service. In total, 53 women completed the online survey, and subsequent analysis generated descriptive statistics and qualitative themes.Results: Responses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women reported attending with infants aged 0-8 weeks of age (72%). The predominant presenting problems identified were sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields. Analysis of the open text qualitative responses revealed one overarching theme ‘Support to continue breastfeeding’ and four subthemes: ‘feeling listened to and not judged’; ‘emotional support and confidence building’; ‘the importance of face-to-face, practical support'; and ‘the need for ongoing, free access’.Discussion: In this study many women were seeking support for ongoing breastfeeding difficulties. Health professionals who had limited breastfeeding knowledge and skills were identified as most unhelpful in providing support with ongoing breastfeeding difficulties. Women valued having access to trained peer counsellors, who had the capacity to provide non-judgemental, face-to-face support; who could sit through a feed; in a space that was ‘safe’; and who could enhance a woman’s confidence with breastfeeding over the course of her full breastfeeding journey. Conclusion: Women described the importance of access to a reactive style of drop-in service, in response to need, which was dedicated to breastfeeding support and which was available locally. Key words: Breast Feeding, Lactation, Community Survey, peer support, peer counsellor, thematic analysis

The Effectiveness of Laid-back Position on Lactation Related Nipple problems and comfort: A meta-analysis

Background The importance of breastfeeding for maternal and child health has become an international consensus. However, it has been found that lactation-related nipple problems are common and there are some important factors affecting the effectiveness of breastfeeding. Multiple studies recommended the laid-back breastfeeding, but the researches are on various levels of quality and the results are controversial.Methods We systematically searched the following twelve databases: Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science, CINAHL, Scopus, SinoMed, Chinese National Knowledge Infrastructure (CNKI), WanFang, and VIP from inception to January 28,2020. All studies reporting the laid-back breastfeeding or biological nurturing were considered, regardless of they are randomized controlled trials. Two trained investigators independently evaluated the quality of the included the articles and screened the data. All the data were analyzed separately using Review Manager Version 5.3 and STATA/SE Version 15.1. Results A total of 12 studies involving 1,936 groups of postpartum women and their newborns were included. The results of meta-analysis showed that nipple trauma (RR = 0.47; 95% CI 0.29,0.75; p < 0.002), nipple pain (RR = 0.25; 95% CI 0.20,0.32; p < 0.00001), the correct posture of latching (RR = 1.22; 95% CI 1.11,1.33; p < 0.00001)and position comfort (ES = 0.01; 95%CI -0.28,0.30; p = 0.006) of experimental group were all better than control group, and the differences were statistically significant ( p < 0.05), which indicates that the laid-back position has a positive effect on maternal breastfeeding. Conclusion Laid-back position has significant advantages in decreasing the incidence of nipple trauma and nipple pain compared with traditional breastfeeding postures, and it appears that laid-back position is conducive to the correct posture of latching. However, current evidence does not show different breastfeeding outcomes in the two groups of position comfort. Laid-back position is helpful to solve lactation-related nipple problems and it can be used as a recommended position for breastfeeding. Key words: Breast-feeding, Biological Nurturing, Laid-back Breastfeeding, Meta-Analysis

The The Role of Breast Sonography and Ductography in the Evaluation of Different Causes of the Nipple Discharge

ABSTRACT Background : The aim of this work is to assess the role of breast sonography and ductography in the evaluation of different causes of nipple discharge. Methods : The study will be carried out on twenty-five female patients referred to the Radiodiagnosis department at Alexandria Main University Hospital presenting with nipple discharge. They were divided into two groups: Group I include 10 patients (40%) with surgically significant nipple discharge who were the patients with unilateral, uniorificial surgically significant colour type nipple discharge .They were investigated by mammography, sonography, and ductography. Group II include 15 patients (60%) with surgically insignificant nipple discharge. They were further subdivided into 9 patients (36%) with unilateral multiorificial and 6 patients (24%) with bilateral nipple discharge. They were subjected to mammography ,sonography without ductography. Results Nipple discharge is the release of fluid from the nipple. It is the third most common breast complaint for women seek medical attention, after lumps and breast pain. It is a symptomatic problem that causes many women both discomfort and anxiety. Conclusion : The current study showed certain diagnostic sonographic features for patients of multiple papillomatosis was agreed with studies carried out Key words : Breast, Ductography, Nipple Corresponding address to : Dr. Ahlam Jamil Al-Ani m.b.b.ch. Al- Faloja Hospital

Noncolorectal, Nonneuroendocrine Liver Metastasis

Noncolorectal, nonneuroendocrine metastases represent a heterogeneous group with variable tumor biology. Successes in the use of hepatectomy for colorectal liver metastases has increased interest in resection of noncolorectal, nonneuroendocrine metastases. Cure rates equivalent to those of colorectal liver metastases have not been achieved, but resection of noncolorectal, nonneuroendocrine metastases can often provide improved overall survival compared with systemic therapy alone or exclusively palliative care. Overall survival outcomes can be achieved with acceptable perioperative morbidity and mortality relative to rates for hepatectomies in general. Prospective data regarding the utilization of resection for noncolorectal, nonneuroendocrine metastases are lacking, but retrospective data are encouraging. In appropriately selected patients with favorable tumor biology and excellent performance status, resection of noncolorectal, nonneuroendocrine may offer a survival benefit. This review contains 1 figure, 2 tables, and 31 references. Key Words: breast cancer, cytoreduction, gastric cancer, GIST, hepatectomy, melanoma, metastasis, ovarian cancer, pancreatic cancer, renal cell carcinoma

Noncolorectal, Nonneuroendocrine Liver Metastasis

Noncolorectal, nonneuroendocrine metastases represent a heterogeneous group with variable tumor biology. Successes in the use of hepatectomy for colorectal liver metastases has increased interest in resection of noncolorectal, nonneuroendocrine metastases. Cure rates equivalent to those of colorectal liver metastases have not been achieved, but resection of noncolorectal, nonneuroendocrine metastases can often provide improved overall survival compared with systemic therapy alone or exclusively palliative care. Overall survival outcomes can be achieved with acceptable perioperative morbidity and mortality relative to rates for hepatectomies in general. Prospective data regarding the utilization of resection for noncolorectal, nonneuroendocrine metastases are lacking, but retrospective data are encouraging. In appropriately selected patients with favorable tumor biology and excellent performance status, resection of noncolorectal, nonneuroendocrine may offer a survival benefit. This review contains 1 figure, 2 tables, and 31 references. Key Words: breast cancer, cytoreduction, gastric cancer, GIST, hepatectomy, melanoma, metastasis, ovarian cancer, pancreatic cancer, renal cell carcinoma