Diagnosis and treatment of chylous leakage after modified radical mastectomy for breast cancer: a case report

The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient’s diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient''s chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient''s axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.     

Complex decongestive physical therapy and low-level laser therapy for the treatment of pediatric congenital lymphedema: a case report

[Purpose] We report the case of a pediatric patient with congenital lymphedema treated with complex decongestive physical therapy and low-level laser therapy. [Subjects and Methods] The patient was a 2 year-old girl who had lymphedema in the left upper limb since birth. Complex decongestive physical therapy and low-level laser therapy were administered for 7 sessions. [Results] The circumferences of the middle of the forearm, elbow joint, wrist, and hand of the left upper limb decreased 0.5, 3, 0.5, and 2 cm, respectively. The moisture content of the left upper limb decreased 70 mL (6.66%), while moisture ratio increased by 0.007%. [Conclusion] Complex decongestive physical therapy and low-level laser therapy are effective for reducing lymphedema in pediatric patients.Key words: Lymphedema, Complex decongestive physical therapy, Low-level laser therapy     

乳腺癌患者新辅助化疗后静息态脑功能活动变化的短期纵向研究

目的本研究旨在探索初诊乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC) 1周期后脑的自发性和同步性功能活动的短期纵向变化。材料与方法本研究共纳入36名行NAC的乳腺癌患者,分别于行NAC前(timepoint 0,TP0)和行NAC第1周期后(timepoint 1,TP1)进行静息态功能磁共振成像(resting-state functional MRI,rs-fMRI)扫描和神经心理测试。低频振幅(amplitude of low-frequency fluctuations,ALFF)和基于种子点的功能连接(functional connectivity, FC)分析用于评估所有被试的自发性和同步性脑活动,采用配对样本t检验进行纵向比较,并对rs-fMRI参数与神经心理测试评分进行相关性分析。结果与TP0相比,乳腺癌患者在TP1的焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分显著下降(P<0.05),其余神经心理测试评分在两次评估之间差异无统计学意义;TP1的右侧额中回、右侧岛叶及左侧背外侧额上回的ALFF值显...     

乳腺癌患者术后化疗的护理

乳腺癌是常见的恶性肿瘤之一,近年来发病呈年轻化上升趋势.化学药物治疗作为乳腺癌治疗的一种有效手段,特别是作为手术后辅助治疗,它可以杀死生长中的肿瘤细胞,可以减少或防止术后肿瘤复发或转移,提高乳腺癌的疗效,使晚期乳腺癌有治愈的可能[1].但是化学药物可致患者出现不同程度的毒副反应及组织脏器损伤,所以在化疗过程中必须精心护理.本文通过对120例乳腺癌患者术后化疗实施护理干预,对保证化疗的正常进行和减轻患者痛苦有重要意义.     

腔内激光闭合术治疗下肢浅静脉曲张术后并发症的护理

目的探讨腔内激光闭合术治疗下肢浅静脉曲张术后并发症的护理措施。方法回顾分析2006年12月至2009年12月采取腔内激光闭合术治疗下肢浅静脉曲张258例,并对术后并发症进行分析总结。结果 258例(共337条肢体)共出现5种并发症,分别为:皮下淤血、水肿148例;皮肤烧伤5例;血栓性静脉炎17例;隐静脉损伤14例;创面感染、伤口延迟愈合2例。结论大隐静脉高位结扎+腔内激光闭塞治疗下肢浅静脉曲张是一项新技术,疗效确切。加强对术后病人的观察和护理,有助于及时发现并处理并发症,促进患者早日复。     

Optical malignancy parameters for monitoring progression of breast cancer neoadjuvant chemotherapy

We introduce and demonstrate use of a novel, diffuse optical tomography (DOT) based breast cancer signature for monitoring progression of neoadjuvant chemotherapy. This signature, called probability of malignancy, is obtained by statistical image analysis of total hemoglobin concentration, blood oxygen saturation, and scattering coefficient distributions in the breast tomograms of a training-set population with biopsy-confirmed breast cancers. A pilot clinical investigation adapts this statistical image analysis approach for chemotherapy monitoring of three patients. Though preliminary, the study shows how to use the malignancy parameter for separating responders from partial-responders and demonstrates the potential utility of the methodology compared to traditional DOT quantification schemes.OCIS codes: (170.3830) Mammography, (170.3880) Medical and biological imaging, (170.1610) Clinical applications, (170.6510) Spectroscopy, tissue diagnostics     

The experience of massage during chemotherapy treatment in breast cancer patients

This study aimed to describe the experience of massage for breast cancer patients during chemotherapy treatment. Ten patients received massage at five occasions. They were interviewed and analysis was conducted using Giorgi's ideas of phenomenological research. The essential meaning of getting massage during chemotherapy was described as a retreat from the feeling of uneasiness toward chemotherapy. Results revealed five themes: the patients experienced distraction from the frightening experience, a turn from negative to positive, a sense of relaxation, a confirmation of caring, and finally they just felt good. In conclusion, the findings of this study show that massage offered a retreat from uneasy, unwanted, negative feelings connected with chemotherapy treatment. It is a treatment that can be added to the arsenal of treatment choices available to the oncological staff.     

Ultrasonographic detection of occult cancer in patients after surgical therapy for breast cancer.

OBJECTIVE: The purpose of this study was to investigate the efficacy of ultrasonography in detecting an occult malignancy after surgery for breast cancer and to assess the imaging and clinical findings associated with a recurrence. METHODS: During a 4-year period, 3329 bilateral whole-breast ultrasonographic examinations were performed to detect occult malignancies clinically and mammographically in 1968 asymptomatic patients after breast cancer surgery. All questionable lesions were confirmed with ultrasonographically guided intervention. This study reviewed ultrasonographic findings and pathologic results of the questionable lesions along with the clinical parameters of the patients. We searched for false-negative cases from the hospital database. RESULTS: Among the 1968 patients, ultrasonography revealed questionable lesions in 57 (2.9%). The questionable lesions were lymph nodes in 42 and masses in 15; of these lesions, 24 were malignant (true-positive) and 33 were benign (false-positive). Ten false-negative cases were identified. The sensitivity and specificity were 70.6% and 98.3%, respectively. The locations of the recurrent lesions were the regional lymph nodes in 14 cases (4, axillary fossa; 4, interpectoral; 4, internal mammary; and 2, supraclavicular lymph nodes) and the breast and mastectomy bed in 7 cases. The mean size of the malignant lymph nodes was larger than that of the benign lymph nodes. Among those with positive examination results, the clinical parameters in the recurrent and nonrecurrent groups were similar. CONCLUSIONS: Postoperative follow-up ultrasonography showed occult malignancies clinically and mammographically in 1.2% of the patients who had been treated for breast cancer. Familiarity with the common location of a tumor recurrence is essential for making an accurate ultrasonographic evaluation in these patients.     

乳腺癌前哨淋巴结活检在新辅助化疗后的应用价值

目的通过对比术前未接受化疗和术前接受新辅助化疗两组乳腺癌患者前哨淋巴结活检的结果,探讨对术前接受新辅助化疗后降期的患者以核素法行前哨淋巴结活检的临床价值。方法以本院2006年4月~2009年3月期间收治的99例乳腺癌患者作为研究对象。术前未行化疗组60例,临床分期为T1~2N0M0,直接行前哨淋巴结活检。术前新辅助化疗组39例,临床分期T2~3N0M0,患者术前先给予3~4个疗程的新辅助化疗,降期为T1~2N0M0后再行前哨淋巴结活检。所有患者术前均经乳晕下4点平均注射99m锝标记的非过滤硫胶体,术中用γ探针探测腋窝具有放射活性的前哨淋巴结并切除,然后常规清扫腋窝Ⅰ、Ⅱ组淋巴结。术后对前哨淋巴结活检和腋窝淋巴结清扫的病理结果进行比较分析。结果A组成功率、假阴性率、灵敏度、特异度、准确性、阳性预测值和阴性预测值分别为98.3%、3.3%、96.7%、100%、98.3%、100%和96.7%。B组分别为100%、10%、90%、100%、94.9%、100%和90.5%。两组比较假阴性率、准确性均无统计学差异。(P均>0.05)。结论对新辅助化疗后降期的局部进展期乳腺癌患者,以核素法行前哨淋巴结活检仍能够获得较高的成功率,同早期乳腺癌患者相比假阴性率没有统计学差异。     

Low-level laser therapy for wound healing: feasibility of wound dressing transillumination

OBJECTIVE: The purpose of this study was to assess the feasibility of exposing wounds during low-level laser therapy (LLLT) by transillumination of the wound dressings. BACKGROUND DATA: LLLT has been associated with accelerated wound healing in chronic ulcers. The usual approach is to remove wound dressings prior to exposure and to treat three to five times weekly. Frequent change of wound dressings is time consuming and costly; it disrupts the healing process, increases the risk of wound infection, and may be traumatic for the patient. METHODS: A double integrating sphere setup was employed to quantify the diffuse transmittance and reflectance of various wound dressings. Differences in transmittance for large area sources and point sources were demonstrated through the use of a diode laser and an incoherent light source. RESULTS: There were a number of gels and membrane style wound dressings with diffuse transmittance of more than 50%. Hence, for these dressings the prescribed radiant exposure to the wound surface could be achieved by increasing the exposure duration, while maintaining reasonable overall treatment times. CONCLUSIONS: Although LLLT by transillumination of wound dressings is feasible for a variety of wound dressings without significant commitments in additional treatment time, the specific transmission of products not included in this study needs to be determined at the intended treatment wavelength. A transillumination approach may facilitate a faster rate of wound healing than LLLT applied to exposed wounds by reducing trauma and the risk of infection.     

1例乳腺癌化疗后截肢患者的危机干预

报告对1例接受左乳腺癌保乳根治术和化疗后合并手足坏疽致截肢而引发心理危机和自杀意念的患者实施危机干预的过程。 根据危机干预6步法：确定问题、保证安全、提供心理支持、提出并验证变通的应对方式、制订计划并承诺实施,在住院、转院到出院期间的12个月内共实施了13次危机干预,取得了良好的干预效果。 患者最终完成截肢手术,度过心理危机,获得成长,重新适应生活。     

High-dose therapy for treatment of breast cancer

Breast cancer remains the second leading cause of cancer deaths despite medical advancements. The use of high-dose therapies in the treatment of breast cancer has become much more common in centers across the country. Deciding whether high-dose therapy is an appropriate treatment option is neither easy nor always straightforward. Nurse practitioners can intervene on behalf of their patients with breast cancer and help them to make thoughtful decisions regarding their care.     

乳腺癌患者PICC置管的护理

目的观察乳腺癌患者PICC导管建立的正确方法,分析放置PICC导管后并发症防治及处理的经验体会。方法采用美国巴德公司(BARD)生产的PICC导管,管长60cm,管腔容积1ml。常规采用贵要静脉置入。结果本组160例穿刺成功率为97.5%,其中常见的并发症为静脉炎、疼痛,经对症处理后均可得到很好的解决。结论该技术在肿瘤患者应用中具有安全、方便、留置时间长、患者痛苦小等优点,为乳腺癌患者化疗开辟了一条安全可靠的给药途径。     

Physical activity during and after adjuvant chemotherapy in patients with breast cancer

Objectives

To describe changes in physical activity levels related to health-enhancing physical activity guidelines during and after adjuvant chemotherapy in a cohort of Swedish patients with breast cancer.

Design

Exploratory clinical prospective longitudinal study with 6 and 12 months of follow-up.

Participants

Forty women treated for breast cancer with adjuvant chemotherapy were included, and 33 women completed the study.

Main outcome measures

The primary outcome was the proportion of participants meeting the health-enhancing physical activity guidelines, both in relative terms (perceived exertion using Borg's rate of perceived exertion scale) and absolute terms (metabolic equivalent).

Results

The proportion of participants meeting the guidelines when leisure-time physical activity was measured in terms of absolute intensity was 81 (25/31) to 94% (31/33) during chemotherapy, 93% (29/31) at 6-month follow-up and 87% (26/30) at 12-month follow-up. Women who had been physically active before their cancer diagnosis and women who had received information about physical activity were more physically active during chemotherapy.

Conclusions

Swedish patients with breast cancer are generally more physically active during adjuvant chemotherapy than has been reported previously in international studies. Physical activity habits prior to cancer diagnosis and information about the benefits of physical activity appear to be important factors for higher levels of physical activity during and after chemotherapy.     

A pilot study of magnetic therapy for hot flashes after breast cancer

The purpose of this randomized placebo-controlled crossover pilot study was to evaluate the effectiveness and acceptability of magnetic therapy for hot flashes among breast cancer survivors. Participants completed a 24-hour baseline hot-flash monitoring session, wore the magnetic devices or placebo for 3 days, completed an after-treatment hot-flash monitoring session, experienced a 10-day washout period, and then crossed over to the opposite study arm. Magnetic devices and placebos were placed on 6 acupressure sites corresponding to hot-flash relief. Complete data were available from 11 survivors of breast cancer. Results indicated magnetic therapy was no more effective than placebo in decreasing hot-flash severity, and contrary to expectations, placebo was significantly more effective than magnets in decreasing hot-flash frequency, bother, interference with daily activities, and overall quality of life. Implications for clinical practice and future research include the need to explore alternative interventions aimed at alleviating hot flashes in this population.