Background
During the last decades transaxillary breast augmentation (TBA) has gained worldwide acceptance Breast augmentation via transaxillary access endoscopically assisted in the subglandular, subfascial, and submuscular planes has been previously described Although TBA is a well-studied procedure, few reports exist concerning the subfascial plane of implant insertion and none exist comparing the three different planes of insertion by TBA

Transaxillary Breast Augmentation: A Prospective Comparison of Subglandular, Subfascial, and Submuscular Implant Insertion

Transaxillary subpectoral augmentation mammaplasty: a single surgeon's 20-year experience.

Transaxillary endoscopic breast augmentation with shaped gel implants.

Breast cancer treatment
may have implications for women’s quality of life and social support, which
refers to mechanisms through which interpersonal relationships protect people
from the detrimental effects of stress. This study’s objective was to analyze
evidence available in the literature concerning social support provided to
women with breast cancer undergoing chemotherapy. The Latin American and
Caribbean Literature on Health Sciences (LILACS), PubMed, Web of Science,
Psycinfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL)
databases were used to select the studies. The papers were pre-selected after
reading titles and abstracts and ten papers were ultimately selected after
fully reading the texts. The studies were summarized, while their
methodological designs and results were noted. The analysis of the studies
shows that social support can be provided to women with breast cancer, such as
emotional, instrumental and informational support. It is apparent that
emotional and instrumental support is provided in the first phase of the
treatment. The main sources of support include the spouses, family members and
friends. Spouses provide emotional support, but mainly provide instrumental
support, while family members and friends are the most important source of
emotional support. The conclusion is that emotional support greatly contributes
to the health-disease continuum, favoring treatment adherence and creating opportunities
for women to express their feelings, positively influencing the treatment.

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Social Support Provided to Women Undergoing Breast Cancer Treatment: A Study Review

Background
Single-incision, transaxillary, robotic-assisted (STAR) thyroid lobectomy using a robotic surgical system is a novel surgical approach that is extensively described in Korean patients. Some have suggested that this experience will not translate into the American population because of differing body habitus and because the mean size of the thyroid nodules removed in Korea are <1 cm. We reviewed our experience with STAR thyroid lobectomy.

Patient factors affecting operative times for single-incision trans-axillary robotic-assisted (STAR) thyroid lobectomy: does size matter?

The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG). Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p < 0.05 significant, or p < 0.017 when Bonferroni correction was applied. All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG. The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.

Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography.

O linfonodo sentinela e o primeiro linfonodo que recebe a drenagem linfatica proveniente do câncer de mama. A sua deteccao tem a finalidade de predizer o estado da axila e evitar o esvaziamento axilar nos pacientes sem comprometimento metastatico. Os autores realizaram uma ampla revisao da literatura, envolvendo os aspectos cirurgicos, de Medicina Nuclear e de Anatomia Patologica do linfonodo sentinela. Muitos estudos demonstraram a eficacia do linfonodo sentinela em predizer o comprometimento axilar. Entretanto, existem varias tecnicas empregadas para a identificacao desse linfonodo, sem haver ainda um consenso em relacao ao metodo mais adequado e reproduzivel. A associacao do corante vital com o probe, ate o presente, e a que tem apresentado os melhores resultados. Tambem nao existe uma padronizacao do exame patologico intra-operatorio do linfonodo sentinela e os indices de falso-negativos encontrados sao bastante variaveis. A biopsia do linfonodo sentinela pode oferecer uma alternativa segura a disseccao axilar e com menos efeitos colaterais nos pacientes com axila clinicamente negativa. Entretanto alguns pontos conflitantes devem ser resolvidos antes que o metodo passe a ser utilizado na pratica com o câncer de mama. O objetivo desse trabalho foi discutir os principais aspectos envolvidos no desenvolvimento e na aplicacao dessa tecnica.

/pdf/linfonodo-sentinela-um-novo-conceito-no-tratamento-cirurgico-13nuo9gcdf.pdf

Linfonodo sentinela: um novo conceito no tratamento cirúrgico do câncer de mama

OBJETIVO: Estabelecer os custos dos controles de qualidade para os radiofarmacos marcados com [99mTc]tecnecio nos servicos de medicina nuclear do Brasil, em atencao as resolucoes RDC no 38/2008 e RDC no 63/2009 editadas pela Agencia Nacional de Vigilância Sanitaria. MATERIAIS E METODOS: Foram apurados precos de materiais de consumo, equipamentos e de mao-de-obra para a realizacao dos controles de qualidade. Os valores foram convertidos para unidades de volume, tempo e outras unidades cabiveis para a determinacao do preco unitario. RESULTADOS: O investimento para aquisicao de materiais de consumo e equipamentos foi estimado ser de R$ 35.500,00. O custo final para o controle de cada kit variou entre R$ 6,44 e R$ 7,80, dependendo do produto a ser analisado e do profissional selecionado para execucao do procedimento. Esses valores podem representar de 0,5% a 10% do valor recebido pelas instituicoes pela realizacao dos exames. Na pratica, o custo efetivo pode ser menor, uma vez que o produto de um kit pode ser utilizado em diversos pacientes. CONCLUSAO: Em face do ganho de qualidade e seguranca dos pacientes, concluimos que os custos da implantacao do programa de controle de qualidade podem ser absorvidos no planejamento financeiro dos servicos de medicina nuclear.

/pdf/avaliacao-dos-custos-para-realizacao-de-controles-de-35itua6td9.pdf

Avaliação dos custos para realização de controles de qualidade de radiofármacos marcados com [99mTc]tecnécio em serviços de medicina nuclear no Brasil

Psychosocial factors associated with disability in patients with non-specific chronic low back pain: A cross-sectional study.

OBJETIVO: Verificar se a mamoplastia de aumento pela via transaxilar apresenta potencial de prejudicar a identificacao futura do linfonodo sentinela. MATERIAIS E METODOS: Estudo prospectivo controlado em que foram selecionadas 22 pacientes divididas em grupo pos-mamoplastia e grupo controle, totalizando 43 mamas (22 no grupo pos-mamoplastia e 21 no grupo controle) avaliadas por meio de linfocintilografia imediatamente apos injecoes periareolares de fitato-99mTc. Os testes estatisticos consideraram como diferencas significativas valores de p < 0,05. RESULTADOS: Todas as mamas do grupo pos-mamoplastia apresentaram drenagem linfatica para a cadeia axilar, sem diferenca com o grupo controle (p = 0,488). A media de linfonodos captantes foi de 1,27 ± 0,46 no grupo pos-mamoplastia e 1,33 ± 0,58 no grupo controle (p = 0,895). A media de tempo para visualizacao do primeiro linfonodo foi de 3,14 ± 4,42 minutos no grupo pos-mamoplastia e 5,48 ± 5,06 minutos no grupo controle, novamente sem diferenca significativa (p = 0,136). CONCLUSAO: A mamoplastia de aumento pela via transaxilar nao acarretou prejuizo na identificacao futura do linfonodo sentinela.

/pdf/linfonodo-sentinela-apos-mamoplastia-de-aumento-pela-via-4f35370ssl.pdf

Airton Seiji Yamada

Papers

Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography.

Linfonodo sentinela: um novo conceito no tratamento cirúrgico do câncer de mama

Avaliação dos custos para realização de controles de qualidade de radiofármacos marcados com [99mTc]tecnécio em serviços de medicina nuclear no Brasil

Psychosocial factors associated with disability in patients with non-specific chronic low back pain: A cross-sectional study.

Linfonodo sentinela após mamoplastia de aumento pela via transaxilar: estudo prospectivo controlado por meio de linfocintilografia em 43 pacientes