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Papers by henrique gebrim

Medicine

Breast cancer is the most common malignancy affecting women worldwide. The insulin-like growth fa... more Breast cancer is the most common malignancy affecting women worldwide. The insulin-like growth factor 1 (IGF-1) gene encodes a protein responsible for a wide variety of physiological processes, including differentiation and cell proliferation. Despite several studies on tumor tissues, no study has evaluated IGF-1 expression in the peripheral blood of women with recurrent breast cancer. In this cross-sectional study, IGF-1 expression in the peripheral blood of 146 women with breast cancer treated approximately 5 years ago was quantified by quantitative reverse transcription polymerase chain. The women were divided into 2 groups: nonrecurrence (n = 85) and recurrence (n = 61). Statistical analysis of the data was performed using ANOVA, Mann-Whitney, and Chisquared tests (P < .05). The results showed no significant difference in IGF-1 expression between the non-recurrence and recurrence groups (P = .988). In the subgroups of patients with lymph node involvement, no statistically significant difference was observed in IGF-1 expression between women with recurrence and those non-recurrence (P = .113). In patients without lymph node metastases, IGF-1 messenger ribonucleic acid (mRNA) expression levels were significantly higher in the non-recurrence group than in the recurrence group (P = .019). Furthermore, using the median IGF-1 mRNA expression as the cutoff point, it was obtained a statistically significant difference in tumor histological grade among women with recurrent breast cancer (P = .042). These data showed significantly higher IGF-1 expression in women without lymph node metastases in the non-recurrence group compared with the recurrence group. In addition, a significant difference was observed in median IGF-1 mRNA expression in relation to tumor histological grade in women with recurrent breast cancer. Abbreviations: IGF-1 = insulin-like growth factor 1, mRNA = messenger ribonucleic acid, RT-qPCR = quantitative reverse transcription polymerase chain reaction, TCGA = the Cancer Genome Atlas.

Mastology, 2021

Introduction: Clinical staging (CS) has great importance for therapeutic programming and prognost... more Introduction: Clinical staging (CS) has great importance for therapeutic programming and prognostic evaluation in patients diagnosed with breast cancer. Malignant breast tumors can be classified according to their immunohistochemical (IHC) profile. The study of the IHC profile can also assist in public health strategies, since they determine therapeutic planning. Objectives: Compare our database with literature data. Methods: The staging database (TNM, Tumor, Nodes and Metastasis) of the CRSM-SP (Pérola Byington Hospital) of patients with breast cancer treated at this institution from January 2010 to December 2019. Results: It was observed that 5.7% of the patients had in situ tumors. In the invasive form of tumors, 22.7% of the patients were diagnosed in CS I. Stage II was the one with the highest occurrence, corresponding to 36.5%. Advanced cases belonging to stages III and IV respectively represented 28.2% and 3.26%. As for the IHC profile of our 10,665 patients, luminal tumors A...

Mastology, 2021

Introduction: Over the last few decades, neoadjuvant chemotherapy (NCT) has played an increasing ... more Introduction: Over the last few decades, neoadjuvant chemotherapy (NCT) has played an increasing role in the management of breast cancer. It allows for an evaluation of the tumour reponse in vivo and may afford a de-escalation of surgeries. Despite advances in neoadjuvant treatment, evidence shows that rates of breast-conserving surgeries (BCT) after NCT are low (51%–68%) even when a patient is eligible for a less agressive surgery. Objectives: To analyze the surgical treatment performed in patients who underwent NCT in clinical stages (CS) II or III within a public health service in Brazil. Methods: A cross-sectional study was conducted with statistical analysis of the database of a public hospital in São Paulo with 11,073 patients treated from January 2009 to December 2020. Results: A total of 11,073 patients with breast cancer were treated in this period and 9,526 surgeries were performed, from which 4,613 (48.4%) were BCS and 4,913 (51.6%) were mastectomies. Among these procedur...

Mastology, 2021

Introduction: Organized mammographic screening led to an increase in the diagnosis of DCIS. In co... more Introduction: Organized mammographic screening led to an increase in the diagnosis of DCIS. In countries with adequate mammographic coverage, the percentage of DCIS reaches 20%. In Brazi, most of the states only perform occasional mammographic screening, and data about DCIS incidence is scarce. Objectives: Analyze and describe clinical, diagnostic, imaging and therapeutic characteristics of patients diagnosed with DCIS and treated at Pérola Byington Hospital (PBH), Brazil. Methods: The official database of PBH from January 2011 to December 2019 showed 11,373 cases of breast cancer, and 812 (7.4%) of them were DCIS. We analyzed retrospectively the medical record of 332 patients who underwent biopsy, vaccum assisted biopsy guided by mammography or ultrasound whose diagnosis was DCIS, and they were treated at the hospital. Patients with previous breast cancer or lobular neoplasia were excluded. We divided the analysis into two groups, based on the type of surgery they underwent, conser...

Mastology, 2021

Introduction: In adults, the thoracic duct carries about four liters of lymph per day, and its in... more Introduction: In adults, the thoracic duct carries about four liters of lymph per day, and its injury can lead to rapid accumulation in the pleural cavity, causing acute and chronic changes in lung dynamics. Thoracic duct injuries are uncommon and occur during surgical procedures in the thoracic region and trauma, such as esophagectomy, mediastinal and pleuro-pulmonary surgical procedures. Surgical injuries have been described after almost all types of thoracic surgical procedures, especially those performed in the upper left thoracic strait. The clinical diagnosis is based most often on the high output of the introduced chest drain, accompanied by a milky aspect. In addition, computed tomography, lymphoscintigraphy and lymphanangiography are possible methods for diagnosis. Clinical series on duct injuries after thoracic surgery report that in approximately 25% to 50% of cases spontaneous closure of the fistula occurs with conservative measures, after the introduction of parenteral ...

Mastology, 2021

Introduction: Breast cancer treatment depends on the diagnostic biopsy and the positivity of the ... more Introduction: Breast cancer treatment depends on the diagnostic biopsy and the positivity of the biomarkers. Diagnostic lumpectomy is available in most centers but requires access to the operating room and can cause deformities, has high cost and morbidity. Vacuum assisted biopsy (VAB) is a less invasive and highly accurate alternative for diagnosis besides being a cheaper outpatient procedure. Objectives: To carry out the cost-minimization analysis between a VAB and a lumpectomy. Methods: Assuming that there is no difference in the accuracy between the two procedures, a cost-minimization analysis was performed. A decision tree model was developed considering patients undergoing VAB or lumpectomy. Depending on the result and the procedure performed, the patient may or may not perform a therapeutic lumpectomy. The analysis was based on a retrospective evaluation of 1,833 VABs at Pérola Byington Hospital (PBH), including the pathological results and the proportion of patients requirin...

Oncotarget, 2020

Background: Cancer and fibroadenoma are the most common breast tumors in women of reproductive ag... more Background: Cancer and fibroadenoma are the most common breast tumors in women of reproductive age. Nuclear factor erythroid 2-related factor 2 (Nrf2) and the nuclear factor kappaB (NF-κB) transcription factor play an important role in the inflammatory process and in cell proliferation. However, few studies have analyzed these markers in breast cancer and fibroadenoma in women of reproductive age. Results: Light microscopy showed a higher concentration of anti-Nrf2 and anti-NF-κB-stained nuclei in breast cancer than in fibroadenoma. The mean percentage of stained nuclei for Nrf2 was 7.12 ± 5.2 and 43.21 ± 19.83 in the control and study groups, respectively (p < 0.0001). The mean percentage of anti-NF-κB was 10.75 ± 7.09 and 56.14 ± 21.19 (mean ± standard deviation) in the control and study groups, respectively (p < 0.0001). Histological grade 3 tumors showed a significantly higher expression of Nrf2 and NF-κB than grade 1 tumors (p < 0.05). Material and methods: This study was approved by the Institutional Review Board of Federal University of Piaui and all patients assigned an inform consent term prior to the study initiation. Nrf2 and NF-κB expression was evaluated by immunohistochemistry in 66 patients, divided into two groups, control (fibroadenoma, n = 36) and study (cancer, n = 30). The data were analyzed using ANOVA test and the statistical significance was established at p < 0.05. Conclusion: Nrf2 and NF-κB expression was significantly higher in breast cancer than in fibroadenoma, in addition to having a greater association with more aggressive tumors.

Mastology, 2018

Objetives: Breast cancer affects about 59,000 Brazilian women annually according to data from INC... more Objetives: Breast cancer affects about 59,000 Brazilian women annually according to data from INCA 2018 (National Cancer Institute) and 14,388 deaths are related to the disease. There are few data about the stage of the disease in our Country. Most of the cases are confirmed in late stages mainly due to the delay in diagnosis and time to initiate the treatment. Pérola Byington Hospital is one of the most important cancer centers specialized breast cancer treatment in Brazil and we are responsible for treating about a thousand new cases of breast cancer annually. In 2005 a model of visits based on quick diagnosis and treatment was implemented named CARE (Centro de Alta Resolutividade-High Resolutivity Center) based on a model of One Stop Clinic. This approach can lead to a downstage of breast cancer stage once the diagnosis and the treatment is substantially quicker. In this study we have evaluated the stage and immunohistochemistry (IHC) subtype of the patients treated in our institution. Methodology: In 2016 we have created a web-based system that helped us to input information about the breast câncer cases treated in Pérola Byington Hospital. This program helped us to better understand our cases of breast cancer regarding the initial stage and the subtype of breast cancer based on IHQ. The main idea was to analyze our data and compare it with the national data and the international literature. Results: We have reviewed 8,420 cases of breast cancer treated in our Hospital between 2011 and 2017. We were able to access the clinical stage in 8,096 cases. The distribution was 4.9% of stage 0, 22.9% of stage I, 39.2% of stage II, 30% of stage III and 3.1% of stage IV at the time of diagnosis. The data regarding the immunohistochemistry subtype was able to be recovered in 7,934 patients. Most of our cases were luminal (A or B)-56.4%. There was 10.3% of both Her2 and hormonal receptor positive and 7.9% of only Her2 positive. The prevalence in our patients of triple negative disease was 25.4% much higher than the literature (around 15%). We have also looked at the Her2 doubtful (Her2 2+) where usually you need a specific test to define it (CISH or FISH test). There were 1,450 cases in this condition and in 28.6% of them the test was not made. Among the cases that made the test we found that 74.7% resulted in CISH negative, 14.1% positive and 11.2% were still inconclusive. The Ministry of Health forces all the Her2 positive in the IHC (3/3) to be tested with a FISH or a CISH test. We found 616 cases of Her2 positive in the IHQ test and negative when CISH was made (7.2%). Conclusions: In our analysis we have found that our institution has more cases of triple negative disease than reported in the literature. Based on national statistics we had substantially fewer cases of advanced disease (only 30% of stage III compared to 60% of INCA report). Probably these findings are related to the quick diagnosis and immediate treatment (surgical or neoadjuvant). There was 17.4%% of cases found to have Her2 uncertain and most of them were tested and became a Her2 negative when CISH was performed (74.7%). We have to look carefully to those patients with Her2 positive in IHC but negative when CISH was done specially because they do not receive trastuzumab according to Brazilian Ministry of Health guidelines a a further study will be made to evaluate that.

Annals of Nuclear Medicine, 2019

Purpose "Chemobrain" is a medical secondary effect of cancer chemotherapy treatment characterized... more Purpose "Chemobrain" is a medical secondary effect of cancer chemotherapy treatment characterized by a general decline in cognition affecting visual and verbal memory, attention, complex problem-solving skills, and motor function. Dopamine (DA) central nervous system neurotransmitters serve an important role in cognition, and changes in DA could potentially explain impaired cognition associated with chemotherapy. Therefore, our objective was to assess in vivo dopaminergic dysfunction in the central nervous system (CNS) of a group of female breast cancer survivors with cognitive impairment following chemotherapy. Methods Twenty-eight women reporting chemobrain were recruited for this study and compared to 22 healthy reference women. Striatal dopamine transporter (DAT) binding ratio was determined by 99m Tc-TRODAT-1 (a highly selective radiotracer for DAT in the dorsal striatum) single-photon emission computed tomography and a quantitative evaluation was obtained by DatQUANT™ software (GE Healthcare). The DAT binding ratio (BR DAT) in the patient and control groups was compared using the Student's t test, a multivariate analysis of variance (MANOVA) was used to compare age, years of schooling and BR DAT. The relationship between continuous variables, such as cognitive impairment and BR DAT was assessed using Pearson correlation test. Results There was a difference in BR DAT between the chemobrain patients and control group. Patients had statistically significant (p < 0.05) lower concentrations of the radiopharmaceutical in the striatum. Conclusions We identified a significant dopaminergic decrease in all regions of the dorsal striatum within the patients reporting cognitive dysfunction after chemotherapy. Therefore, our results indicate a possible role of dopamine transporter in the physiopathology of chemobrain, even out of the acute phase of symptoms.

Gynecologic Oncology, 2018

Objective: Evaluate the impact of clinicopathologic characteristics and adjuvant treatment on sur... more Objective: Evaluate the impact of clinicopathologic characteristics and adjuvant treatment on survival outcomes in early stage uterine carcinosarcoma patients. Methods: We performed a retrospective cohort study of women with stage I or II uterine carcinosarcoma at our institution between March 1990 and June 2016. All pathology had been reviewed and confirmed by gynecologic pathologists. Data were extracted from the electronic medical record. Descriptive and comparative statistics were used to compare clinicopathologic characteristics. Univariable and multivariable analyses were performed for survival outcomes. Results: 140 patients were identified. Median age was 67 years (range: 36-91). Median followup was 39.1 months (2.9-297.4). The majority of patients had stage IA (67%) versus stage IB (21%) or stage II (11%) disease. The majority of patients (63%) received adjuvant treatment: vaginal brachytherapy only (14%); whole pelvic radiation therapy only (16%); chemotherapy only (n=13, 9%); combination chemotherapy and vaginal brachytherapy (15%); combination chemotherapy and whole pelvic radiation (9%). 52 patients (37%) received no adjuvant therapy.

Clinical research in cardiology : official journal of the German Cardiac Society, Jan 2, 2018

To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients be... more To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, an...

Reprodução & Climatério, 2017

A criopreservação de oócitos contribuiu para o avanço das técnicas em reprodução humana nas últim... more A criopreservação de oócitos contribuiu para o avanço das técnicas em reprodução humana nas últimas décadas. A metodologia tem sua aplicação na preservação da fertilidade, em programas de ovodoação, como estratégia para redução do número de embriões extranumerários criopreservados com manipulação de menor número de oócitos a fresco e para acúmulo de oócitos em ciclos com reduzida resposta ovariana. A partir do princípio de que todo cidadão tem direito a saúde, é dever do Estado garantir o acesso a todos os tipos de tratamento. O Centro de Referência da Saúde da Mulher-Hospital Pérola Byington implantou a técnica de vitrificação de oócitos em 2010, aprimora os protocolos continuamente e busca melhores taxas de sobrevida, fertilização, clivagem e gestação. Relatamos as duas primeiras gestaç ões, com nascimento, obtidas a partir de oócitos vitrificados em nosso Centro, que comprovam a viabilidade da aplicação dessa técnica e oferecem, assim, atendimento ao público com equidade e gratuidade integral.

Cadernos de Saúde Pública, 2016

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Segurança e viabilidade de um novo formato de retalho toracoepigástrico na reconstrução da parede... more Segurança e viabilidade de um novo formato de retalho toracoepigástrico na reconstrução da parede torácica em câncer de mama localmente avançado: um estudo transversal Introduction: Patients who undergo radical mastectomy with extensive tissue loss require a surgical procedure for rapid and simple closure of the lesion, with good skin coverage and minimal morbidity, to make them eligible for early complementary treatments. We evaluated the efficacy and safety of a new format of thoracoepigastric flap with patients in the Semi-Fowler position during surgery. We hypothesized that this procedure would achieve proper closure of large lesions and ensure the survival of the flap. Methods: All consecutive patients who underwent radical mastectomy between 2009 and 2014 and had chest wall reconstruction were evaluated. The main outcomes evaluated were the viability of the flap and effectiveness of the surgical closure. Results: During the study period, we operated on 29 patients with locally advanced (90%) or recurrent tumor (10%), and one patient was operated on bilaterally (total of 30 flaps). Of the study sample, 23 patients (79%) were at stage III and 6 (21%), at stage IV. The dimensions of the resected areas varied from 20 x 15 cm to 13 x 9 cm (average 15.5 x 11.6 cm). The dimensions of the thoracoepigastric flaps varied from 25 x 12 to 18 x 8 cm (average 21.3 x 10.4 cm). There were only 2 cases of dehiscence (7%), which resolved without surgical intervention, and one case of hematoma, which was drained surgically. One patient died on the eleventh postoperative day. Conclusion: Thoracoepigastric flaps were effective and safe, did not require the use of other flaps or skin grafting, and adequately closed the donor areas in all cases. All patients, except the patient who died, were eligible for complementary treatment one month after surgery.

Rev Bras Mastologia, Mar 1, 2008

Saúde, Ética & Justiça, 1999

Resumo: A proposta deste estudo foi, uma investigação das vítimas de estupro em cidades de pequen... more Resumo: A proposta deste estudo foi, uma investigação das vítimas de estupro em cidades de pequeno porte do Estado de São Paulo. Foi desenvolvida uma pesquisa sobre estupro, no Instituto Médico Legal de Piraju-SP, no período de julho de 1994 a julho de 1997 (três anos), com 62 mulheres submetidas a perícia sexológica para conjunção carnal. A faixa etária das periciadas variou entre 4 e 54 anos (média de 13,8 anos), sendo que a maioria (87,1%) possuía idade inferior a 18 anos. Das 62 periciadas, 95,1% eram solteiras. A cor predominante foi a branca com 87,1% e, a estudante foi a vítima mais freqüente com 59,7%. O intervalo entre a "queixa" e a perícia, variou de exames realizados no mesmo dia a meses após, sendo que, 74,3% foram examinadas antes de 15 dias entre a possível conjunção carnal e a perícia. De todas as periciadas, 37,1% apresentavam hímen íntegro, 45,2% apresentavam rotura himenal não recente, 4,8% hímen complacente e 12,9% apresentavam rotura himenal recente. A comprovação da conjunção carnal ocorreu em 25,8%, sendo utilizados na perícia, a pesquisa dos três sinais de certeza de conjunção carnal (rotura himenal recente, presença de espermatozóides no canal vaginal e gravidez). Entre os casos de conjunção carnal positiva, a gravidez foi diagnosticada em 37,5% (9,6% de todas as periciadas). A pesquisa de espermatozóides no canal vaginal resultou positiva em 9,7%. De todas a periciadas, os agentes agressores acusados 64,5% foram "não parentes" e, 35,5% parentes da vítima. Entre os parentes, o pai foi o agente agressor acusado em 41,0% dos casos. Observou-se que 58,1% das periciadas tinham idade entre 11 e 17 anos, o que vem comprovar que a vítima de estupro no interior é regra geral estudante e adolescente.

Journal of the Senologic International Society, Oct 10, 2012

INTRODUCTION: Carcinoma in situ breast cancer is characterized by proliferation of malignant cell... more INTRODUCTION: Carcinoma in situ breast cancer is characterized by proliferation of malignant cells confined to the breast duct or lobule, without invading the basement membrane. Comprises a wide variety of lesions may vary from foci millimeter (microcalcifications in mammography in 80% of cases) to extensive involvement of the breast, microinvasion, and associated with outbreaks of axillary invasion and dissemination. Due to the introduction of routine mammography screening and prevention of new cases of breast cancer, a significant increase of initial cases diagnosed with ductal carcinoma in situ (DCIS). The incidence rates that were historically low, around 3% incidence of tumors in situ in the 70 s, suffered increases in recent years, accounting today for about 15 to 25% of new cases of breast cancer. The early screening leads to an increased incidence of invasive breast cancer and in situ, but with reduction of the diagnosis of advanced forms. The diagnosis, the prevailing form of detection is mammography screening, representing 95% of DCIS diagnosed, and biopsy, which should be done whenever there is a suspicion, indicating mammotomy or location followed by stereotactic surgery. The Van Nuys Prognostic Index (VNPI), a model proposed by Silverstein, which summarizes the main pathological features of lesions associated with age of onset of the lesion, determining prognosis and recommendations of conduct. The sum of the values ??will vary from 4 to 12, with three identifiable sub-groups: a good prognosis (4-6), moderate outcome (7-9) and poor prognosis (10-12). The analyzes show the relationship between VNPI and clinical findings can be used in the definition of treatment to be adopted. OBJECTIVE: this study is to compare the staging by which gives us a relationship of disease extent and prognosis in ductal carcinoma in situ in different age groups to assess whether this condition has an impact on certain age providing clinical data to better target screening tests and perhaps future treatments. MATERIALS AND METHODS: We conducted a retrospective, case series from a review of medical records at the Hospital Perola Byington in the period from 05/03/2011 to 05/03/12 separating the patients by their histopathological diagnosis, staging, and age in order to assess whether DCIS incindia more in a given age. RESULTS: 518 patients were diagnosed with breast cancer within a year of study, among them 57 were diagnosed with DCIS, of which 21 were younger than 50 years and 36 aged over 50 years. Statistically through this study we demonstrated in our service a higher incidence among patients over 50 years (63%) compared with patients below 50 years. CONCLUSION: Our results allow us to assert that there is an increase of incencia of DCIS in patients undergoing menopause, they tend to have better prognosis and longer survival free of local recurrence and without progression to more aggressive forms compared with younger patients. Based on our data and scientific knowledge acquired in recent years, the early mammographic diagnosis will most conservative treatment options for breast and axilla in patients diagnosed with DCIS, reducing costs and improving quality of life.

Medicine

Breast cancer is the most common malignancy affecting women worldwide. The insulin-like growth fa... more Breast cancer is the most common malignancy affecting women worldwide. The insulin-like growth factor 1 (IGF-1) gene encodes a protein responsible for a wide variety of physiological processes, including differentiation and cell proliferation. Despite several studies on tumor tissues, no study has evaluated IGF-1 expression in the peripheral blood of women with recurrent breast cancer. In this cross-sectional study, IGF-1 expression in the peripheral blood of 146 women with breast cancer treated approximately 5 years ago was quantified by quantitative reverse transcription polymerase chain. The women were divided into 2 groups: nonrecurrence (n = 85) and recurrence (n = 61). Statistical analysis of the data was performed using ANOVA, Mann-Whitney, and Chisquared tests (P < .05). The results showed no significant difference in IGF-1 expression between the non-recurrence and recurrence groups (P = .988). In the subgroups of patients with lymph node involvement, no statistically significant difference was observed in IGF-1 expression between women with recurrence and those non-recurrence (P = .113). In patients without lymph node metastases, IGF-1 messenger ribonucleic acid (mRNA) expression levels were significantly higher in the non-recurrence group than in the recurrence group (P = .019). Furthermore, using the median IGF-1 mRNA expression as the cutoff point, it was obtained a statistically significant difference in tumor histological grade among women with recurrent breast cancer (P = .042). These data showed significantly higher IGF-1 expression in women without lymph node metastases in the non-recurrence group compared with the recurrence group. In addition, a significant difference was observed in median IGF-1 mRNA expression in relation to tumor histological grade in women with recurrent breast cancer. Abbreviations: IGF-1 = insulin-like growth factor 1, mRNA = messenger ribonucleic acid, RT-qPCR = quantitative reverse transcription polymerase chain reaction, TCGA = the Cancer Genome Atlas.

Mastology, 2021

Introduction: Clinical staging (CS) has great importance for therapeutic programming and prognost... more Introduction: Clinical staging (CS) has great importance for therapeutic programming and prognostic evaluation in patients diagnosed with breast cancer. Malignant breast tumors can be classified according to their immunohistochemical (IHC) profile. The study of the IHC profile can also assist in public health strategies, since they determine therapeutic planning. Objectives: Compare our database with literature data. Methods: The staging database (TNM, Tumor, Nodes and Metastasis) of the CRSM-SP (Pérola Byington Hospital) of patients with breast cancer treated at this institution from January 2010 to December 2019. Results: It was observed that 5.7% of the patients had in situ tumors. In the invasive form of tumors, 22.7% of the patients were diagnosed in CS I. Stage II was the one with the highest occurrence, corresponding to 36.5%. Advanced cases belonging to stages III and IV respectively represented 28.2% and 3.26%. As for the IHC profile of our 10,665 patients, luminal tumors A...

Mastology, 2021

Introduction: Over the last few decades, neoadjuvant chemotherapy (NCT) has played an increasing ... more Introduction: Over the last few decades, neoadjuvant chemotherapy (NCT) has played an increasing role in the management of breast cancer. It allows for an evaluation of the tumour reponse in vivo and may afford a de-escalation of surgeries. Despite advances in neoadjuvant treatment, evidence shows that rates of breast-conserving surgeries (BCT) after NCT are low (51%–68%) even when a patient is eligible for a less agressive surgery. Objectives: To analyze the surgical treatment performed in patients who underwent NCT in clinical stages (CS) II or III within a public health service in Brazil. Methods: A cross-sectional study was conducted with statistical analysis of the database of a public hospital in São Paulo with 11,073 patients treated from January 2009 to December 2020. Results: A total of 11,073 patients with breast cancer were treated in this period and 9,526 surgeries were performed, from which 4,613 (48.4%) were BCS and 4,913 (51.6%) were mastectomies. Among these procedur...

Mastology, 2021

Introduction: Organized mammographic screening led to an increase in the diagnosis of DCIS. In co... more Introduction: Organized mammographic screening led to an increase in the diagnosis of DCIS. In countries with adequate mammographic coverage, the percentage of DCIS reaches 20%. In Brazi, most of the states only perform occasional mammographic screening, and data about DCIS incidence is scarce. Objectives: Analyze and describe clinical, diagnostic, imaging and therapeutic characteristics of patients diagnosed with DCIS and treated at Pérola Byington Hospital (PBH), Brazil. Methods: The official database of PBH from January 2011 to December 2019 showed 11,373 cases of breast cancer, and 812 (7.4%) of them were DCIS. We analyzed retrospectively the medical record of 332 patients who underwent biopsy, vaccum assisted biopsy guided by mammography or ultrasound whose diagnosis was DCIS, and they were treated at the hospital. Patients with previous breast cancer or lobular neoplasia were excluded. We divided the analysis into two groups, based on the type of surgery they underwent, conser...

Mastology, 2021

Introduction: In adults, the thoracic duct carries about four liters of lymph per day, and its in... more Introduction: In adults, the thoracic duct carries about four liters of lymph per day, and its injury can lead to rapid accumulation in the pleural cavity, causing acute and chronic changes in lung dynamics. Thoracic duct injuries are uncommon and occur during surgical procedures in the thoracic region and trauma, such as esophagectomy, mediastinal and pleuro-pulmonary surgical procedures. Surgical injuries have been described after almost all types of thoracic surgical procedures, especially those performed in the upper left thoracic strait. The clinical diagnosis is based most often on the high output of the introduced chest drain, accompanied by a milky aspect. In addition, computed tomography, lymphoscintigraphy and lymphanangiography are possible methods for diagnosis. Clinical series on duct injuries after thoracic surgery report that in approximately 25% to 50% of cases spontaneous closure of the fistula occurs with conservative measures, after the introduction of parenteral ...

Mastology, 2021

Introduction: Breast cancer treatment depends on the diagnostic biopsy and the positivity of the ... more Introduction: Breast cancer treatment depends on the diagnostic biopsy and the positivity of the biomarkers. Diagnostic lumpectomy is available in most centers but requires access to the operating room and can cause deformities, has high cost and morbidity. Vacuum assisted biopsy (VAB) is a less invasive and highly accurate alternative for diagnosis besides being a cheaper outpatient procedure. Objectives: To carry out the cost-minimization analysis between a VAB and a lumpectomy. Methods: Assuming that there is no difference in the accuracy between the two procedures, a cost-minimization analysis was performed. A decision tree model was developed considering patients undergoing VAB or lumpectomy. Depending on the result and the procedure performed, the patient may or may not perform a therapeutic lumpectomy. The analysis was based on a retrospective evaluation of 1,833 VABs at Pérola Byington Hospital (PBH), including the pathological results and the proportion of patients requirin...

Oncotarget, 2020

Background: Cancer and fibroadenoma are the most common breast tumors in women of reproductive ag... more Background: Cancer and fibroadenoma are the most common breast tumors in women of reproductive age. Nuclear factor erythroid 2-related factor 2 (Nrf2) and the nuclear factor kappaB (NF-κB) transcription factor play an important role in the inflammatory process and in cell proliferation. However, few studies have analyzed these markers in breast cancer and fibroadenoma in women of reproductive age. Results: Light microscopy showed a higher concentration of anti-Nrf2 and anti-NF-κB-stained nuclei in breast cancer than in fibroadenoma. The mean percentage of stained nuclei for Nrf2 was 7.12 ± 5.2 and 43.21 ± 19.83 in the control and study groups, respectively (p < 0.0001). The mean percentage of anti-NF-κB was 10.75 ± 7.09 and 56.14 ± 21.19 (mean ± standard deviation) in the control and study groups, respectively (p < 0.0001). Histological grade 3 tumors showed a significantly higher expression of Nrf2 and NF-κB than grade 1 tumors (p < 0.05). Material and methods: This study was approved by the Institutional Review Board of Federal University of Piaui and all patients assigned an inform consent term prior to the study initiation. Nrf2 and NF-κB expression was evaluated by immunohistochemistry in 66 patients, divided into two groups, control (fibroadenoma, n = 36) and study (cancer, n = 30). The data were analyzed using ANOVA test and the statistical significance was established at p < 0.05. Conclusion: Nrf2 and NF-κB expression was significantly higher in breast cancer than in fibroadenoma, in addition to having a greater association with more aggressive tumors.

Mastology, 2018

Objetives: Breast cancer affects about 59,000 Brazilian women annually according to data from INC... more Objetives: Breast cancer affects about 59,000 Brazilian women annually according to data from INCA 2018 (National Cancer Institute) and 14,388 deaths are related to the disease. There are few data about the stage of the disease in our Country. Most of the cases are confirmed in late stages mainly due to the delay in diagnosis and time to initiate the treatment. Pérola Byington Hospital is one of the most important cancer centers specialized breast cancer treatment in Brazil and we are responsible for treating about a thousand new cases of breast cancer annually. In 2005 a model of visits based on quick diagnosis and treatment was implemented named CARE (Centro de Alta Resolutividade-High Resolutivity Center) based on a model of One Stop Clinic. This approach can lead to a downstage of breast cancer stage once the diagnosis and the treatment is substantially quicker. In this study we have evaluated the stage and immunohistochemistry (IHC) subtype of the patients treated in our institution. Methodology: In 2016 we have created a web-based system that helped us to input information about the breast câncer cases treated in Pérola Byington Hospital. This program helped us to better understand our cases of breast cancer regarding the initial stage and the subtype of breast cancer based on IHQ. The main idea was to analyze our data and compare it with the national data and the international literature. Results: We have reviewed 8,420 cases of breast cancer treated in our Hospital between 2011 and 2017. We were able to access the clinical stage in 8,096 cases. The distribution was 4.9% of stage 0, 22.9% of stage I, 39.2% of stage II, 30% of stage III and 3.1% of stage IV at the time of diagnosis. The data regarding the immunohistochemistry subtype was able to be recovered in 7,934 patients. Most of our cases were luminal (A or B)-56.4%. There was 10.3% of both Her2 and hormonal receptor positive and 7.9% of only Her2 positive. The prevalence in our patients of triple negative disease was 25.4% much higher than the literature (around 15%). We have also looked at the Her2 doubtful (Her2 2+) where usually you need a specific test to define it (CISH or FISH test). There were 1,450 cases in this condition and in 28.6% of them the test was not made. Among the cases that made the test we found that 74.7% resulted in CISH negative, 14.1% positive and 11.2% were still inconclusive. The Ministry of Health forces all the Her2 positive in the IHC (3/3) to be tested with a FISH or a CISH test. We found 616 cases of Her2 positive in the IHQ test and negative when CISH was made (7.2%). Conclusions: In our analysis we have found that our institution has more cases of triple negative disease than reported in the literature. Based on national statistics we had substantially fewer cases of advanced disease (only 30% of stage III compared to 60% of INCA report). Probably these findings are related to the quick diagnosis and immediate treatment (surgical or neoadjuvant). There was 17.4%% of cases found to have Her2 uncertain and most of them were tested and became a Her2 negative when CISH was performed (74.7%). We have to look carefully to those patients with Her2 positive in IHC but negative when CISH was done specially because they do not receive trastuzumab according to Brazilian Ministry of Health guidelines a a further study will be made to evaluate that.

Annals of Nuclear Medicine, 2019

Purpose "Chemobrain" is a medical secondary effect of cancer chemotherapy treatment characterized... more Purpose "Chemobrain" is a medical secondary effect of cancer chemotherapy treatment characterized by a general decline in cognition affecting visual and verbal memory, attention, complex problem-solving skills, and motor function. Dopamine (DA) central nervous system neurotransmitters serve an important role in cognition, and changes in DA could potentially explain impaired cognition associated with chemotherapy. Therefore, our objective was to assess in vivo dopaminergic dysfunction in the central nervous system (CNS) of a group of female breast cancer survivors with cognitive impairment following chemotherapy. Methods Twenty-eight women reporting chemobrain were recruited for this study and compared to 22 healthy reference women. Striatal dopamine transporter (DAT) binding ratio was determined by 99m Tc-TRODAT-1 (a highly selective radiotracer for DAT in the dorsal striatum) single-photon emission computed tomography and a quantitative evaluation was obtained by DatQUANT™ software (GE Healthcare). The DAT binding ratio (BR DAT) in the patient and control groups was compared using the Student's t test, a multivariate analysis of variance (MANOVA) was used to compare age, years of schooling and BR DAT. The relationship between continuous variables, such as cognitive impairment and BR DAT was assessed using Pearson correlation test. Results There was a difference in BR DAT between the chemobrain patients and control group. Patients had statistically significant (p < 0.05) lower concentrations of the radiopharmaceutical in the striatum. Conclusions We identified a significant dopaminergic decrease in all regions of the dorsal striatum within the patients reporting cognitive dysfunction after chemotherapy. Therefore, our results indicate a possible role of dopamine transporter in the physiopathology of chemobrain, even out of the acute phase of symptoms.

Gynecologic Oncology, 2018

Objective: Evaluate the impact of clinicopathologic characteristics and adjuvant treatment on sur... more Objective: Evaluate the impact of clinicopathologic characteristics and adjuvant treatment on survival outcomes in early stage uterine carcinosarcoma patients. Methods: We performed a retrospective cohort study of women with stage I or II uterine carcinosarcoma at our institution between March 1990 and June 2016. All pathology had been reviewed and confirmed by gynecologic pathologists. Data were extracted from the electronic medical record. Descriptive and comparative statistics were used to compare clinicopathologic characteristics. Univariable and multivariable analyses were performed for survival outcomes. Results: 140 patients were identified. Median age was 67 years (range: 36-91). Median followup was 39.1 months (2.9-297.4). The majority of patients had stage IA (67%) versus stage IB (21%) or stage II (11%) disease. The majority of patients (63%) received adjuvant treatment: vaginal brachytherapy only (14%); whole pelvic radiation therapy only (16%); chemotherapy only (n=13, 9%); combination chemotherapy and vaginal brachytherapy (15%); combination chemotherapy and whole pelvic radiation (9%). 52 patients (37%) received no adjuvant therapy.

Clinical research in cardiology : official journal of the German Cardiac Society, Jan 2, 2018

To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients be... more To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, an...

Reprodução & Climatério, 2017

A criopreservação de oócitos contribuiu para o avanço das técnicas em reprodução humana nas últim... more A criopreservação de oócitos contribuiu para o avanço das técnicas em reprodução humana nas últimas décadas. A metodologia tem sua aplicação na preservação da fertilidade, em programas de ovodoação, como estratégia para redução do número de embriões extranumerários criopreservados com manipulação de menor número de oócitos a fresco e para acúmulo de oócitos em ciclos com reduzida resposta ovariana. A partir do princípio de que todo cidadão tem direito a saúde, é dever do Estado garantir o acesso a todos os tipos de tratamento. O Centro de Referência da Saúde da Mulher-Hospital Pérola Byington implantou a técnica de vitrificação de oócitos em 2010, aprimora os protocolos continuamente e busca melhores taxas de sobrevida, fertilização, clivagem e gestação. Relatamos as duas primeiras gestaç ões, com nascimento, obtidas a partir de oócitos vitrificados em nosso Centro, que comprovam a viabilidade da aplicação dessa técnica e oferecem, assim, atendimento ao público com equidade e gratuidade integral.

Cadernos de Saúde Pública, 2016

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Segurança e viabilidade de um novo formato de retalho toracoepigástrico na reconstrução da parede... more Segurança e viabilidade de um novo formato de retalho toracoepigástrico na reconstrução da parede torácica em câncer de mama localmente avançado: um estudo transversal Introduction: Patients who undergo radical mastectomy with extensive tissue loss require a surgical procedure for rapid and simple closure of the lesion, with good skin coverage and minimal morbidity, to make them eligible for early complementary treatments. We evaluated the efficacy and safety of a new format of thoracoepigastric flap with patients in the Semi-Fowler position during surgery. We hypothesized that this procedure would achieve proper closure of large lesions and ensure the survival of the flap. Methods: All consecutive patients who underwent radical mastectomy between 2009 and 2014 and had chest wall reconstruction were evaluated. The main outcomes evaluated were the viability of the flap and effectiveness of the surgical closure. Results: During the study period, we operated on 29 patients with locally advanced (90%) or recurrent tumor (10%), and one patient was operated on bilaterally (total of 30 flaps). Of the study sample, 23 patients (79%) were at stage III and 6 (21%), at stage IV. The dimensions of the resected areas varied from 20 x 15 cm to 13 x 9 cm (average 15.5 x 11.6 cm). The dimensions of the thoracoepigastric flaps varied from 25 x 12 to 18 x 8 cm (average 21.3 x 10.4 cm). There were only 2 cases of dehiscence (7%), which resolved without surgical intervention, and one case of hematoma, which was drained surgically. One patient died on the eleventh postoperative day. Conclusion: Thoracoepigastric flaps were effective and safe, did not require the use of other flaps or skin grafting, and adequately closed the donor areas in all cases. All patients, except the patient who died, were eligible for complementary treatment one month after surgery.

Rev Bras Mastologia, Mar 1, 2008

Saúde, Ética & Justiça, 1999

Resumo: A proposta deste estudo foi, uma investigação das vítimas de estupro em cidades de pequen... more Resumo: A proposta deste estudo foi, uma investigação das vítimas de estupro em cidades de pequeno porte do Estado de São Paulo. Foi desenvolvida uma pesquisa sobre estupro, no Instituto Médico Legal de Piraju-SP, no período de julho de 1994 a julho de 1997 (três anos), com 62 mulheres submetidas a perícia sexológica para conjunção carnal. A faixa etária das periciadas variou entre 4 e 54 anos (média de 13,8 anos), sendo que a maioria (87,1%) possuía idade inferior a 18 anos. Das 62 periciadas, 95,1% eram solteiras. A cor predominante foi a branca com 87,1% e, a estudante foi a vítima mais freqüente com 59,7%. O intervalo entre a "queixa" e a perícia, variou de exames realizados no mesmo dia a meses após, sendo que, 74,3% foram examinadas antes de 15 dias entre a possível conjunção carnal e a perícia. De todas as periciadas, 37,1% apresentavam hímen íntegro, 45,2% apresentavam rotura himenal não recente, 4,8% hímen complacente e 12,9% apresentavam rotura himenal recente. A comprovação da conjunção carnal ocorreu em 25,8%, sendo utilizados na perícia, a pesquisa dos três sinais de certeza de conjunção carnal (rotura himenal recente, presença de espermatozóides no canal vaginal e gravidez). Entre os casos de conjunção carnal positiva, a gravidez foi diagnosticada em 37,5% (9,6% de todas as periciadas). A pesquisa de espermatozóides no canal vaginal resultou positiva em 9,7%. De todas a periciadas, os agentes agressores acusados 64,5% foram "não parentes" e, 35,5% parentes da vítima. Entre os parentes, o pai foi o agente agressor acusado em 41,0% dos casos. Observou-se que 58,1% das periciadas tinham idade entre 11 e 17 anos, o que vem comprovar que a vítima de estupro no interior é regra geral estudante e adolescente.

Journal of the Senologic International Society, Oct 10, 2012

INTRODUCTION: Carcinoma in situ breast cancer is characterized by proliferation of malignant cell... more INTRODUCTION: Carcinoma in situ breast cancer is characterized by proliferation of malignant cells confined to the breast duct or lobule, without invading the basement membrane. Comprises a wide variety of lesions may vary from foci millimeter (microcalcifications in mammography in 80% of cases) to extensive involvement of the breast, microinvasion, and associated with outbreaks of axillary invasion and dissemination. Due to the introduction of routine mammography screening and prevention of new cases of breast cancer, a significant increase of initial cases diagnosed with ductal carcinoma in situ (DCIS). The incidence rates that were historically low, around 3% incidence of tumors in situ in the 70 s, suffered increases in recent years, accounting today for about 15 to 25% of new cases of breast cancer. The early screening leads to an increased incidence of invasive breast cancer and in situ, but with reduction of the diagnosis of advanced forms. The diagnosis, the prevailing form of detection is mammography screening, representing 95% of DCIS diagnosed, and biopsy, which should be done whenever there is a suspicion, indicating mammotomy or location followed by stereotactic surgery. The Van Nuys Prognostic Index (VNPI), a model proposed by Silverstein, which summarizes the main pathological features of lesions associated with age of onset of the lesion, determining prognosis and recommendations of conduct. The sum of the values ??will vary from 4 to 12, with three identifiable sub-groups: a good prognosis (4-6), moderate outcome (7-9) and poor prognosis (10-12). The analyzes show the relationship between VNPI and clinical findings can be used in the definition of treatment to be adopted. OBJECTIVE: this study is to compare the staging by which gives us a relationship of disease extent and prognosis in ductal carcinoma in situ in different age groups to assess whether this condition has an impact on certain age providing clinical data to better target screening tests and perhaps future treatments. MATERIALS AND METHODS: We conducted a retrospective, case series from a review of medical records at the Hospital Perola Byington in the period from 05/03/2011 to 05/03/12 separating the patients by their histopathological diagnosis, staging, and age in order to assess whether DCIS incindia more in a given age. RESULTS: 518 patients were diagnosed with breast cancer within a year of study, among them 57 were diagnosed with DCIS, of which 21 were younger than 50 years and 36 aged over 50 years. Statistically through this study we demonstrated in our service a higher incidence among patients over 50 years (63%) compared with patients below 50 years. CONCLUSION: Our results allow us to assert that there is an increase of incencia of DCIS in patients undergoing menopause, they tend to have better prognosis and longer survival free of local recurrence and without progression to more aggressive forms compared with younger patients. Based on our data and scientific knowledge acquired in recent years, the early mammographic diagnosis will most conservative treatment options for breast and axilla in patients diagnosed with DCIS, reducing costs and improving quality of life.