6 Misconceptions About Breast Cancer — Health Hub from Cleveland Clinic

Caros,

Perto de terminar o Outubro Rosa, mando um texto interessante da Cleveland Clinic com os principais mitos e confusões acerca do Câncer de Mama. Vale a pena ler.

http://health.clevelandclinic.org/2012/10/6-misconceptions-about-breast-cancer/

6 Misconceptions About Breast Cancer

I asked my colleagues at the Cleveland Clinic Breast Center what they perceive to be patients' most common misconceptions about breast cancer diagnosis, treatment and care.

Combining our list, these six misconceptions rose to the top:

1. "If I have an annual mammogram, I don't need to examine my breasts."

It is important to understand that effective breast cancer screening includes both mammograms and self-breast awareness. A recent study conducted by Mayo Clinic and published in the American Journal of Surgery, conducted over an eight-year period, looked at 1,222 patients with newly diagnosed breast cancer. It found that 13 percent of these patients had a normal mammogram within the 12 months prior to their diagnosis of breast cancer. Knowing your breasts can play a critical role in the early detection of breast cancer, even when a woman has annual screening mammograms.

2. "I feel something in my breast, but my mammogram and/or ultrasound were normal. I'm sure I'm okay."

Feeling a lump, nodule or anything of concern should always prompt consultation with your doctor. Palpable areas often turn out to be normal breast tissue, but they could also be cancerous even though a woman has recently had a normal mammogram and/or ultrasound. For this reason, it is best to have a health professional perform a breast exam on you and consider both the imaging and "feeling" characteristics to determine if further treatment is needed.   

3. "I don't need annual mammograms – I need MRIs."

Many national health groups, including the American Cancer Society, have endorsed screening breast magnetic resonance imaging (MRI) as useful adjunct (not substitute) for women with a 20 percent or greater lifetime risk of developing breast cancer. However, MRI has a significant false positive rate. These same groups have explicitly recommended against annual MRI screenings because the average American woman has only a 1 in 8 (12.5 percent) lifetime risk of developing breast cancer. If you are concerned because your personal and family history puts you at greater risk for breast cancer, you should talk with your doctor about breast MRI.

4. "I shouldn't have a yearly mammogram because the radiation dosage is too high."

There is no scientific evidence that associates annual mammograms beginning at age 40 with an increased risk from radiation. The effective dosage received from a routine screening mammogram is similar to the amount of background radiation exposure that a woman normally receives from sources in her environment over a three-month period.

5. "Thermography is an effective substitute for a mammogram."

Thermography is the making of images of the breasts' radiant infrared energy for the purpose of detecting cancer. In a June 2011 report, the Food and Drug Administration released its views on thermography.  This report said the FDA "was not aware of any valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical conditions, including the early detection of breast cancer or other breast disease" and that it was "concerned that women will….not receive needed mammograms" if they relied solely on thermography.

6. "I should have the same breast cancer treatment my friend had."

This is a misconception I encounter almost daily in my practice and the one I dislike the most.  Since breast cancer consists of a wide range of diseases, there are many different treatment options. Moreover, there have been many advances in treatment over the past 20 years. What was the standard of care even a few years ago may be obsolete today.  It is important for a woman to select a healthcare provider who provides evidence-based treatment options and takes time to explain the risks and benefits of each in order to help her understand the best choice for her particular disease and body.

As some of the most common misconceptions, I hope this helps you stay informed. Knowing the facts can help safeguard your health.

More information

Cleveland Clinic Breast Center

Download a Breast Cancer Treatment Guide
Breast Cancer Clinical Trials at Cleveland Clinic

Michael Cowher, MD

Michael Cowher, MD, is a breast surgeon who thinks he has the best job in the world: caring for women and men regarding breast disease.

Caso Clínico para New England de 31/10

Caros,

Segue caso clínico para discussão no New England de 31/10 enviado pelo Dr. Cláudio:

• Mulher de 29 anos com dor abdominal, febre e perda de peso
• Case 31-2013 — A 29-Year-Old Man with Abdominal Pain, Fever, and Weight Loss. N Engl J Med 2013; 369:1453-1461

Abraços,

Quanto café é demais?

Quanto café é café demais? Já sabemos?

Artigo publicado na Mayo Clinic coloca um pouquinho mais de lenha na fogueira da discussão sobre efeitos da bebida que muitos consagram como o Nectar dos Deuses.

http://www.mayoclinicproceedings.org/article/S0025-6196(13)00578-8/abstract?rss=yes

Association of Coffee Consumption With All-Cause and Cardiovascular Disease Mortality

Abstract 

Objective

Fonte: http://www.precisionnutrition.com

To evaluate the association between coffee consumption and mortality from all causes and from cardiovascular disease.

Patients and Methods

Data from the Aerobics Center Longitudinal Study representing 43,727 participants with 699,632 person-years of follow-up were included. Baseline data were collected by an in-person interview on the basis of standardized questionnaires and a medical examination, including fasting blood chemistry analysis, anthropometry, blood pressure, electrocardiography, and a maximal graded exercise test, between February 3, 1971, and December 30, 2002. Cox regression analysis was used to quantify the association between coffee consumption and all-cause and cause-specific mortality.

Results

During the 17-year median follow-up, 2512 deaths occurred (804 [32%] due to cardiovascular disease). In multivariate analyses, coffee intake was positively associated with all-cause mortality in men. Men who drank more than 28 cups of coffee per week had higher all-cause mortality (hazard ratio [HR], 1.21; 95% CI, 1.04-1.40). However, after stratification based on age, younger (<55 years old) men and women showed a significant association between high coffee consumption (>28 cups per week) and all-cause mortality after adjusting for potential confounders and fitness level (HR, 1.56; 95% CI, 1.30-1.87 for men; and HR, 2.13; 95% CI, 1.26-3.59 for women).

Conclusion

In this large cohort, a positive association between coffee consumption and all-cause mortality was observed in men and in men and women younger than 55 years. On the basis of these findings, it seems appropriate to suggest that younger people avoid heavy coffee consumption (ie, averaging >4 cups per day). However, this finding should be assessed in future studies of other populations.

Abbreviations and Acronyms: ACLS, Aerobics Center Longitudinal Study, BMI, body mass index, CRF, cardiorespiratory fitness, CVD, cardiovascular disease

New Guidelines Released for Acute Pancreatitis Management

New Guidelines Released for Acute Pancreatitis Management | shared via feedly mobile

Fonte da foto: wakegastro.com

The American College of Gastroenterology has issued updated guidelines on the diagnosis, workup, nutrition, and management for patients with acute pancreatitis (AP). The new recommendations were published online July 30 and in the September issue of the American Journal of Gastroenterology.

AP is one of the most prevalent gastrointestinal diseases, and prevalence has been increasing in recent years. The AP case fatality rate has fallen over time, but there has been no change in the overall population mortality rate.

Within 1 week of onset (early AP), a systemic inflammatory response syndrome (SIRS) and/or organ failure may develop, and subsequently (after 1 week), there may be local complications.

"In order to be properly diagnosed with acute pancreatitis the pain should be severe," lead author Scott Tenner, MD, MPH, director of the Greater New York Endoscopy Surgical Center and associate professor of medicine at the State University of New York, said in a news release. "Patients can be falsely diagnosed if the criteria are not followed. In addition we recommend that a CT scan only be performed for patients when their diagnosis is not clear or if they have not had improvement 48-72 hours after hospital admission."

Two of the following 3 criteria should therefore be present to diagnose AP:

• characteristic (severe) abdominal pain,
• serum amylase and/or lipase exceeding 3 times the upper limit of normal, and/or
• characteristic abdominal imaging findings (strong recommendation, moderate quality of evidence).

"During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early and late management of the disease," the guidelines authors write.

Specific Recommendations

• On presentation, patients should immediately be evaluated for hemodynamic status and receive necessary resuscitative measures.
• Patients with AP should receive early, aggressive intravenous hydration, under close observation, unless contraindicated by cardiovascular and/or renal comorbidities. This intervention is most effective within the first 12 to 24 hours but may be of little benefit thereafter.
• Patients with AP and concurrent acute cholangitis should undergo endoscopic retrograde cholangiopancreatography (ERCP) within 24 hours of admission. This procedure combines upper endoscopy and radiography to delineate and intervene in problems affecting the bile and pancreatic ducts.
• To reduce the risk for severe post-ERCP pancreatitis, high-risk patients should receive pancreatic duct stents and/or postprocedure rectal nonsteroidal anti-inflammatory drug suppositories.
• Clinical symptoms and laboratory findings typically allow AP diagnosis. Therefore, pancreatic contrast-enhanced computed tomography and/or magnetic resonance imaging should be performed only in patients in whom the diagnosis is unclear or who do not improve clinically.
• Whenever feasible, patients with organ failure and/or SIRS should be admitted to an intensive care unit or intermediary care setting.
• In patients with severe AP and/or sterile necrosis, routine use of prophylactic antibiotics is not recommended.
• Antibiotics known to penetrate pancreatic necrosis may reduce morbidity and mortality in patients with infected necrosis, thereby delaying intervention.
• Patients with mild AP without nausea and vomiting can immediately start oral feedings.
• Patients with severe AP should receive enteral nutrition to prevent infectious complications. However, parenteral nutrition should be avoided in these patients.
• No intervention is needed for asymptomatic pancreatic and/or extrapancreatic necrosis and/or pseudocysts, regardless of size, location, and/or extension.
• Stable patients with infected necrosis should delay surgical, radiologic, and/or endoscopic drainage, preferably for 4 weeks, to allow time for a wall to develop around the necrosis.
• The guidelines also provide recommendations for determining the etiology of the condition, including evaluation of all patients with transabdominal ultrasound.
• No funding source was involved in the development of these guidelines, and the guidelines authors have disclosed no relevant financial relationships.

Am J Gastroenterol. 2013;108:1400-1415. Abstract

Fonte: MEDSCAPE

Troponina na rotina laboratorial do HUWC e o Consenso da ACCF para sua interpretação

Caros,

A troponina foi definitivamente incorporada na rotina laboratorial do HUWC!

Aproveitando o ensejo, segue o ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations que traz recomendações sobre o uso da troponina em diversas situações clínicas. Lembra que nem sempre sua elevação representa infarto, mas que é um sensível marcador de necrose miocárdica. Esse consenso sugere ainda um algoritmo para decisão clínica. Entre as recomendações, seguem:

"Among the recommendations:

Fonte: www.thailabonline.com

• Troponin testing should be performed only if clinically indicated for suspected MI.
• For nonischemic clinical conditions, routine testing is not advised, except for cardiac prognosis in patients with chronic kidney disease and patients undergoing chemotherapy who have drug-induced cardiac injury.
• For patients with non-ST-segment elevation acute coronary syndrome, global risk assessment — rather than any single risk marker — should be used to guide therapeutic decisions."

Abraços,

Teste da Mistura: como interpretar?

TESTE DA MISTURA

Fonte: http://www.hepcentro.com.br/images/coag.gif

O que é o teste de mistura?

O teste de mistura é muito utilizado para investigação inicial de exames de triagem de hemostasia com resultados anormais: Tempo de Protrombina (TP) ou Tempo de Tromboplastina Parcial Ativado (TTPA) "prolongados" (tempo em segundos maior que o limite superior de normalidade). O teste de mistura consiste na repetição do teste (TP e/ou TTPA) em uma mistura, em iguais proporções, do plasma do paciente com "pool" de plasmas normais.

Como o resultado do teste de mistura deve ser interpretado?

Um TP ou TTPA prolongados podem indicar duas possibilidades:

a) deficiência de um ou mais fatores da coagulação necessários para a normalidade do teste

b) presença de inibidor(es) que impede a formação do coágulo medida pelo teste. Em cada uma destas situações o teste de mistura mostrará um comportamento diferente.

No caso das deficiências de fatores, o teste de mistura revelará "normalização do resultado". O fator que está deficiente será suprido pelo "pool" de plasmas normais e desta forma haverá correção do teste (TP ou TTPA).

Na presença de inibidores da coagulação, o teste de mistura revelará manutenção do prolongamento do teste. Isto se dá, pois os inibidores (em geral anticorpos) presentes no plasma do paciente também interferem com o "pool" de plasmas normais e o teste permanece prolongado.

Como se comporta o teste de mistura em pacientes em uso de anticoagulantes?

Depende do anticoagulante. Anticoagulação oral por antagonistas da vitamina K (dicumarínicos e warfarin) leva à produção de fatores II, VII, IX e X funcionalmente deficientes. Desta forma, plasmas de pacientes em uso destes medicamentos comportam-se como plasmas com deficiência de fatores, ou seja, haverá correção dos tempos de TP e TTPA com o teste de mistura.

Já a heparina, provoca inibição de fatores (em particular os fatores II e X ativados) e, sendo assim, o teste de mistura se comportará como o observado para presença de inibidores, não havendo correção com o teste de mistura.

Como proceder quando o teste de mistura mostra correção dos tempos de TP ou TTPA?

Não havendo uso de anticoagulação oral, deve-se proceder à dosagem de fatores específicos da coagulação. Os fatores a serem dosados dependem da suspeita clínica e do comportamento dos demais teste de triagem de hemostasia para cada caso.

Como proceder quando o teste de mistura mostra manutenção do prolongamento dos tempos de TP ou TTPA?

Não havendo uso de heparina, deve-se proceder à investigação de inibidores inespecíficos (anticoagulante lúpico, anticorpo anti-cardiolipina) ou específicos (anticorpos contra fatores específicos da coagulação).

A presença de inibidor sempre causará teste de mistura com manutenção do prolongamento dos tempos de TP ou TTPA?

Ocasionalmente, quando o título de anticorpos for muito baixo ou o anticorpo for de baixa afinidade, poderá ocorrer normalização dos tempos do teste. Nestes casos, uma pesquisa mais sensível de inibidores (Pesquisa de inibidores da coagulação) indicará.sua presença.

Fonte: Laboratório Fleury

Convite para Jantar Científico pela Dra. Helane Gurgel

Caros,

A Dra. Helane Gurgel, endocrinologista formada no HUWC e diretora médica responsável pela qualidade e relacionamento médico do laboratório Pasteur estende convite para Jantar Científico organizado pelo Laboratório Pasteur, Unimagem e DASA com o tema:

Avaliação por imagem das lesões hipofisárias.

Mais informações abaixo:

Abraços,

Caso Clínico New England 24/10/2013

Caros,

Segue Caso Clínico para discussão no New England de 24/10/2013:

• Homem de 74 anos com nódulos pulmonares e pênfigo vulgar
• Case 28-2011: A 74-Year-Old Man with Pemphigus Vulgaris and Lung Nodules

Abraços,

Declaração de Helsinki - JAMA Online First

JAMA. Published online October 19, 2013. doi:10.1001/jama.2013.281316
http://jama.jamanetwork.com/article.aspx?articleid=1760319

Viewpoint | October 19, 2013

The Declaration of Helsinki, 50 Years Later FREEONLINE FIRST

Paul Ndebele, PhD¹

[+] Author Affiliations

JAMA. Published online October 19, 2013. doi:10.1001/jama.2013.281316

Text Size: A A A

Article

References

Fifty years and 7 revisions later, the 2013 version of the Declaration of Helsinki includes several important changes. By changing the format and including several subsections, the revised declaration enhances and improves clarity regarding specific issues. By having specific issues covered under these subsections, the declaration is now “ bolder” in the way it addresses specific issues. The new formatting will also be welcomed by readers because the subsections improve the readability of the document. By so doing, the Declaration of Helsinki is a better and more important authority at what it is aimed at achieving—providing guidance on conducting medical research involving humans.

Sessão de Clínica Médica 18/10/2013 - Distúrbios de coagulação

Caros,

A sessão de sexta-feira 18/10/2013 abordou o tema distúrbios de coagulação com base em caso clínico de uma paciente com extensas equimoses.

Seguem, para download, o artigo que embasou a discussão e a apresentação em formato PPT do R1 Tales:

• Why Is My Patient Bleeding Or Bruising? Hematol Oncol Clin N Am 26 (2012) 321–344.
• Apresentação PPT do R1 de Clínica Tales Torricelli

Pode também visualizar a apresentação abaixo:

Abraços,