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[PMID]:27771242
[Au] Autor:Morton D; Batchelar D; Hilts M; Berrang T; Crook J
[Ad] Endereço:Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia, Canada; Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, Canada. Electronic address: dmorton@bccancer.bc.ca.
[Ti] Título:Incorporating three-dimensional ultrasound into permanent breast seed implant brachytherapy treatment planning.
[So] Source:Brachytherapy;16(1):167-173, 2017 Jan - Feb.
[Is] ISSN:1873-1449
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Planning permanent breast seed implant (PBSI) brachytherapy using CT alone may reduce treatment accuracy because of differences in seroma visualization compared with ultrasound (US). This study evaluates dosimetric effects of seroma delineation in PBSI and the potential impact of incorporating three-dimensional (3D) US into PBSI treatment planning. METHODS AND MATERIALS: Spatially coregistered CT and 3D US images from 10 patients were retrospectively analyzed to simulate the PBSI procedure. Seromas contoured on CT and US defined clinical target volumes, CTV and CTV , which were expanded to create planning target volumes (PTVs). PBSI plans were generated using PTV alone, and the resulting coverage to PTV was evaluated. To assess the potential impact of transferring to an US-guided procedure, the CT-based plans were centered on CTV . The volume encompassed by both PTVs was used to evaluate how 3D US can affect the planning procedure. RESULTS: Median (range) PTV V was 95.6% (93.3-97.3%), resulting in PTV coverage of 91.5% (80.5-97.9%). Centering plans on CTV decreased PTV V by a mean of 10 ± 8%, and increased PTV V by 5 ± 4%. The combined PTVs were a mean 9±6% larger than PTV . Acceptable dosimetry to the combined PTVs resulted in sufficient coverage to individual PTVs but with a mean 11 ± 24% increase to skin dose and 6 ± 8% increase in breast V . CONCLUSIONS: Differences in seroma visualization have dosimetric effects in PBSI. CT-based plans can underdose US-defined volumes and may not adequately translate to an US-guided procedure. Implementing 3D US into planning can potentially compensate for differences in delineation.
[Mh] Termos MeSH primário: Braquiterapia/métodos
Neoplasias da Mama/radioterapia
Complicações Pós-Operatórias/diagnóstico por imagem
Planejamento da Radioterapia Assistida por Computador/métodos
Seroma/diagnóstico por imagem
Tomografia Computadorizada por Raios X
Ultrassonografia
[Mh] Termos MeSH secundário: Neoplasias da Mama/diagnóstico por imagem
Feminino
Seres Humanos
Imagem Tridimensional
Radiometria
Dosagem Radioterapêutica
Radioterapia Adjuvante
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180125
[Lr] Data última revisão:
180125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28756017
[Au] Autor:Moody JA; Botham SJ; Dahill KE; Wallace DL; Hardwicke JT
[Ad] Endereço:GKT School of Medical Education, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
[Ti] Título:Complications following completion lymphadenectomy versus therapeutic lymphadenectomy for melanoma - A systematic review of the literature.
[So] Source:Eur J Surg Oncol;43(9):1760-1767, 2017 Sep.
[Is] ISSN:1532-2157
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Completion lymph node dissection (CLND) following a positive sentinel lymph node biopsy (SLNB) has been reported to be less morbid than lymphadenectomy for palpable disease (therapeutic lymph node dissection; TLND). The reporting of morbidity data can be heterogeneous, and hence no 'average' surgical complication rates of these procedures has been reported. This review aims to determine complications rates to inform patients undergoing surgery for metastatic melanoma. METHODS: A systematic review of English-language literature from 2000 to 2017, reporting morbidity information about CLND and TLND for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of post-operative complications were constructed using a random effects statistical model. RESULTS: After application of inclusion and exclusion criteria, 18 articles progressed to the final analysis. In relation to TLND (1627 patients), the overall incidence of surgical complications was 39.3% (95% CI 32.6-46.2); including wound infection/breakdown 25.4% (95% CI: 20.9-30.3); lymphoedema 20.9% (95% CI: 13.8-29.1); and seroma 20.4% (95% CI: 15.9-25.2). For CLND (1929 patients), the overall incidence of surgical complications was 37.2% (95% CI 27.6-47.4); including wound infection/breakdown 21.6% (95% CI: 13.8-30.6); lymphoedema 18% (95% CI: 12.5-24.2); and seroma 17.9% (95% CI: 10.3-27). The complication rate was marginally lower for CLND but not to statistical significance. DISCUSSION: This study provides information about the incidence of complications after CLND and TLND. It can be used to counsel patients about the procedures and it sets a benchmark against which surgeons can audit their practice.
[Mh] Termos MeSH primário: Excisão de Linfonodo/efeitos adversos
Melanoma/cirurgia
Linfonodo Sentinela/patologia
Infecção da Ferida Cirúrgica/etiologia
[Mh] Termos MeSH secundário: Seres Humanos
Excisão de Linfonodo/métodos
Metástase Linfática
Linfedema/etiologia
Melanoma/secundário
Biópsia de Linfonodo Sentinela
Seroma/etiologia
Deiscência da Ferida Operatória/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170731
[St] Status:MEDLINE


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[PMID]:28715445
[Au] Autor:Di Napoli A; Pepe G; Giarnieri E; Cippitelli C; Bonifacino A; Mattei M; Martelli M; Falasca C; Cox MC; Santino I; Giovagnoli MR
[Ad] Endereço:Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy.
[Ti] Título:Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma.
[So] Source:PLoS One;12(7):e0181097, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Late breast implant seroma may be the presentation of a breast implant-associated anaplastic large cell lymphoma (BI-ALCL), which claims for a prompt recognition. However, BI-ALCL diagnosis on fine-needle aspiration (FNA) might be challenging for pathologists lacking experience with peri-implant breast effusions. Sixty-seven late breast implant seromas collected by FNA from 50 patients were evaluated by Papanicolaou smear stain and immunocytochemistry on cell blocks. A diagnostic algorithm based on the cellular composition, cell morphology and percentage of CD30+ cells was developed. Histological evaluation of the corresponding peri-prosthetic capsules was also performed. Most of the effusions (91% of the samples) were classified as reactive and 9% as BI-ALCL. In the BI-ALCL cases, medium-to-large atypical cells expressing CD30 represented more than 70% of the cellularity, whereas in in the reactive effusions CD30+ elements were extremely rare (<5%) and consisted of non-atypical elements. The reactive effusions were categorized into three patterns: i) acute infiltrate with prominent neutrophilic component (33% of the samples); ii) mixed infiltrate characterized by a variable number of neutrophils, lymphocytes and macrophages (30% of the samples); iii) chronic infiltrate composed predominantly of T lymphocytes or macrophages with only sporadic granulocytes (37% of the samples). The inflammatory cytological patterns were consistent with the histology of the corresponding capsules. Our results indicate that cytological analysis of late breast implant effusions, supported by the knowledge of the heterogeneous cytomorphological spectrum of late seromas, is a valuable approach for the early recognition of BI-ALCL.
[Mh] Termos MeSH primário: Implante Mamário
Neoplasias da Mama/patologia
Linfoma Anaplásico de Células Grandes/patologia
Seroma/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antígenos CD/metabolismo
Antígenos de Diferenciação Mielomonocítica/metabolismo
Complexo CD3/metabolismo
Feminino
Rearranjo Gênico
Seres Humanos
Antígeno Ki-1/metabolismo
Klebsiella oxytoca/isolamento & purificação
Linfócitos/citologia
Linfócitos/metabolismo
Macrófagos/citologia
Macrófagos/metabolismo
Meia-Idade
Neutrófilos/citologia
Neutrófilos/metabolismo
Pseudomonas aeruginosa/isolamento & purificação
Receptores de Antígenos de Linfócitos T gama-delta/genética
Receptores de Antígenos de Linfócitos T gama-delta/metabolismo
Seroma/microbiologia
Serratia marcescens/isolamento & purificação
Staphylococcus aureus/isolamento & purificação
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antigens, CD); 0 (Antigens, Differentiation, Myelomonocytic); 0 (CD3 Complex); 0 (CD68 antigen, human); 0 (Ki-1 Antigen); 0 (Receptors, Antigen, T-Cell, gamma-delta)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170718
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0181097


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[PMID]:28688644
[Au] Autor:Zhu W; Yang J; Iqbal J; Peck Y; Fan C; Wang DA
[Ad] Endereço:Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.
[Ti] Título:A mussel-inspired double-crosslinked tissue adhesive on rat mastectomy model: seroma prevention and in vivo biocompatibility.
[So] Source:J Surg Res;215:173-182, 2017 Jul.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Seroma formation is a common postsurgical complication of breast cancer surgery. It delays wound healing and may lead to other more serious complications. Conventional methods of reducing seroma formation through suturing or placement of surgical drainage produce inconsistent clinical outcomes. Tissue adhesives are viable alternatives but most of them are unsuitable for internal use and for large-area applications because of weak tissue adhesion strength or biocompatibility issues. The aim of this study was to evaluate the efficacy and biocompatibility of a mussel-inspired double-crosslinked tissue adhesive (DCTA) in reducing seroma formation after mastectomy. MATERIALS AND METHODS: Thirty-six female Sprague-Dawley rats were randomly assigned to either the saline control group (n = 12), the TISSEEL sealant (Baxter) group (n = 12), or the DCTA group (n = 12). After performing a mastectomy and applying the corresponding treatment, the efficacy of DCTA was evaluated by measurement of seroma volume while its biocompatibility was assessed via micronuclei test and histopathologic examination. RESULTS: During the 1-wk postsurgical period, the average total seroma volume of DCTA was significantly lower than the saline control group. Importantly, the mean seroma volume in DCTA showed a decreasing trend, whereas those in TISSEEL and saline control groups showed otherwise. The application of DCTA showed no genotoxic effect on the host and no severe inflammation. CONCLUSIONS: This study demonstrates that the good tissue adhesion strength and stability of DCTA were successful in reducing seroma formation over a period of 1 wk. Furthermore, the results also showed that it is biocompatible, which makes it suitable for large-area, internal use.
[Mh] Termos MeSH primário: Materiais Biocompatíveis/uso terapêutico
Adesivo Tecidual de Fibrina/uso terapêutico
Mastectomia
Complicações Pós-Operatórias/prevenção & controle
Seroma/prevenção & controle
Adesivos Teciduais/uso terapêutico
[Mh] Termos MeSH secundário: Animais
Bivalves
Feminino
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/patologia
Distribuição Aleatória
Ratos
Ratos Sprague-Dawley
Seroma/diagnóstico
Seroma/etiologia
Seroma/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biocompatible Materials); 0 (Fibrin Tissue Adhesive); 0 (Tissue Adhesives)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE


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[PMID]:28624524
[Au] Autor:Ball JF; Sheena Y; Tarek Saleh DM; Forouhi P; Benyon SL; Irwin MS; Malata CM
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
[Ti] Título:A direct comparison of porcine (Strattice™) and bovine (Surgimend™) acellular dermal matrices in implant-based immediate breast reconstruction.
[So] Source:J Plast Reconstr Aesthet Surg;70(8):1076-1082, 2017 Aug.
[Is] ISSN:1878-0539
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Acellular dermal matrix (ADM) assisted implant-based breast reconstruction (IBBR) has grown in popularity over traditional submuscular techniques. Numerous human, bovine or porcine derived ADMs are available with the type used varying considerably worldwide. Yet, comparative evidence for the efficacy of different ADMs particularly xenogenic is limited. This study directly compares early outcomes of porcine (Strattice™) and bovine (Surgimend™) ADMs in IBBR. METHOD: Retrospective study of sequential experience of immediate IBBR using Strattice or Surgimend ADM. Data was collected for patients undergoing ADM assisted IBBR after prophylactic or therapeutic mastectomy in Cambridge (October 2011-March 2016). Patient demographics, adjuvant and neoadjuvant therapies, operative details, postoperative management and outcomes were analysed. KEY RESULTS: Total of 81 patients underwent IBBR with ADM; 38 bilateral and 43 unilateral (n = 119 breasts). Strattice was used in 30 breasts (25%) and Surgimend in 89 (75%). Analysis of patient specific variables showed statistical significance only for higher mastectomy weight in the Strattice group (367.1 ± 159.3 g versus 296.3 ± 133.4 g; P = 0.0379). Strattice was associated with higher rates of skin erythema post-operatively (16.7% versus 4.5%; P = 0.044). Analysed per woman or per breast, there was no statistically significant difference in rates of haematoma, infection, wound dehiscence, skin necrosis or seroma, although there was a trend towards more complications with Strattice. CONCLUSION: This study found significantly higher rates of skin erythema and a trend towards higher complication rates with Strattice in IBBR. Randomised controlled trials comparing different ADM outcomes are needed to inform best practice.
[Mh] Termos MeSH primário: Derme Acelular
Neoplasias da Mama/terapia
Mama/patologia
Colágeno/uso terapêutico
Mamoplastia
Pele/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Animais
Implantes de Mama
Bovinos
Colágeno/efeitos adversos
Eritema/etiologia
Feminino
Hematoma/etiologia
Seres Humanos
Mamoplastia/efeitos adversos
Mastectomia
Meia-Idade
Necrose
Tamanho do Órgão
Reoperação
Estudos Retrospectivos
Seroma/etiologia
Deiscência da Ferida Operatória/etiologia
Infecção da Ferida Cirúrgica/etiologia
Suínos
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Surgimend); 0 (strattice); 9007-34-5 (Collagen)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170619
[St] Status:MEDLINE


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[PMID]:28601567
[Au] Autor:Temming LA; Raghuraman N; Carter EB; Stout MJ; Rampersad RM; Macones GA; Cahill AG; Tuuli MG
[Ad] Endereço:Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO. Electronic address: temmingl@wudosis.wustl.edu.
[Ti] Título:Impact of evidence-based interventions on wound complications after cesarean delivery.
[So] Source:Am J Obstet Gynecol;217(4):449.e1-449.e9, 2017 Oct.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A number of evidence-based interventions have been proposed to reduce post-cesarean delivery wound complications. Examples of such interventions include appropriate timing of preoperative antibiotics, appropriate choice of skin antisepsis, closure of the subcutaneous layer if subcutaneous depth is ≥2 cm, and subcuticular skin closure with suture rather than staples. However, the collective impact of these measures is unclear. OBJECTIVE: We sought to estimate the impact of a group of evidence-based surgical measures (prophylactic antibiotics administered before skin incision, chlorhexidine-alcohol for skin antisepsis, closure of subcutaneous layer, and subcuticular skin closure with suture) on wound complications after cesarean delivery and to estimate residual risk factors for wound complications. STUDY DESIGN: We conducted a secondary analysis of data from a randomized controlled trial of chlorhexidine-alcohol vs iodine-alcohol for skin antisepsis at cesarean delivery from 2011-2015. The primary outcome for this analysis was a composite of wound complications that included surgical site infection, cellulitis, seroma, hematoma, and separation within 30 days. Risk of wound complications in women who received all 4 evidence-based measures (prophylactic antibiotics within 60 minutes of cesarean delivery and before skin incision, chlorhexidine-alcohol for skin antisepsis with 3 minutes of drying time before incision, closure of subcutaneous layer if ≥2 cm of depth, and subcuticular skin closure with suture) were compared with those women who did not. We performed logistic regression analysis limited to patients who received all the evidence-based measures to estimate residual risk factors for wound complications and surgical site infection. RESULTS: Of 1082 patients with follow-up data, 349 (32.3%) received all the evidence-based measures, and 733 (67.7%) did not. The risk of wound complications was significantly lower in patients who received all the evidence-based measures compared with those who did not (20.3% vs 28.1%; adjusted relative risk, 0.75; 95% confidence interval, 0.58-0.95). The impact appeared to be driven largely by a reduction in surgical site infections. Among patients who received all the evidence-based measures, unscheduled cesarean delivery was the only significant risk factor for wound complications (27.5% vs 16.1%; adjusted relative risk, 1.71; 95% confidence interval, 1.12-2.47) and surgical site infection (6.9% vs 1.6%; relative risk, 3.74; 95% confidence interval, 1.18-11.92). Other risk factors, which include obesity, smoking, diabetes mellitus, chorioamnionitis, surgical experience, and skin incision type, were not significant among patients who received all of the 4 evidence-based measures. CONCLUSION: Implementation of evidence-based measures significantly reduces wound complications, but the residual risk remains high, which suggests the need for additional interventions, especially in patients who undergo unscheduled cesarean deliveries, who are at risk for wound complications even after receiving current evidence-based measures.
[Mh] Termos MeSH primário: Cesárea
Prática Clínica Baseada em Evidências
[Mh] Termos MeSH secundário: Adulto
Anti-Infecciosos Locais/administração & dosagem
Antibioticoprofilaxia
Celulite (Flegmão)/prevenção & controle
Clorexidina/administração & dosagem
Corioamnionite/epidemiologia
Diabetes Mellitus/epidemiologia
Emergências
Feminino
Hematoma/prevenção & controle
Seres Humanos
Missouri/epidemiologia
Obesidade/epidemiologia
Gravidez
Fatores de Risco
Seroma/prevenção & controle
Fumar/epidemiologia
Deiscência da Ferida Operatória/prevenção & controle
Infecção da Ferida Cirúrgica/prevenção & controle
Técnicas de Sutura
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170612
[St] Status:MEDLINE


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[PMID]:28590982
[Au] Autor:McGuire P
[Ti] Título:Reply: Risk Factor Analysis for Capsular Contracture, Malposition, and Late Seroma in Subjects Receiving Natrelle 410 Form-Stable Silicone Breast Implants.
[So] Source:Plast Reconstr Surg;140(3):500e, 2017 09.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Implantes de Mama
Seroma
[Mh] Termos MeSH secundário: Implante Mamário
Contratura
Análise Fatorial
Seres Humanos
Desenho de Prótese
Géis de Silicone
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Silicone Gels)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003614


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[PMID]:28590983
[Au] Autor:Chung B; Hall-Findlay EJ
[Ad] Endereço:Banff Plastic Surgery, Banff, Alberta, Canada.
[Ti] Título:Late Seromas in Natrelle 410 Form-Stable Silicone Breast Implants.
[So] Source:Plast Reconstr Surg;140(3):500e-501e, 2017 09.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Implantes de Mama
Seroma
[Mh] Termos MeSH secundário: Implante Mamário
Seres Humanos
Géis de Silicone
Silicones
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Silicone Gels); 0 (Silicones)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003615


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[PMID]:28590981
[Au] Autor:McGuire P
[Ad] Endereço:Parkcrest Plastic Surgery, 845 North New Ballas Court, St. Louis, Mo. 63141, pmcguiremd@sbcglobal.net.
[Ti] Título:Reply: Late Seromas in Natrelle 410 Form-Stable Silicone Breast Implants.
[So] Source:Plast Reconstr Surg;140(3):501e-502e, 2017 09.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Implantes de Mama
Seroma
[Mh] Termos MeSH secundário: Implante Mamário
Seres Humanos
Géis de Silicone
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Silicone Gels)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003617


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[PMID]:28539245
[Au] Autor:Khavanin N; Qiu CS; Mlodinow AS; Vu MM; Dorfman RG; Fine NA; Kim JYS
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
[Ti] Título:External validation of the breast reconstruction risk assessment calculator.
[So] Source:J Plast Reconstr Aesthet Surg;70(7):876-883, 2017 Jul.
[Is] ISSN:1878-0539
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The Breast reconstruction Risk Assessment (BRA) Score estimates patient-specific risk for postsurgical complications using an individual's unique combination of preoperative variables. In this report, we externally validate the BRA Score models for surgical site infection, seroma, and explantation in a large sample of intra-institutional patients who underwent prosthetic breast reconstruction. METHODS: We reviewed all initiated tissue expander/implant reconstructions by the senior authors from January 2004 to December 2015. BRA Score risk estimates were computed for each patient and compared against observed rates of complications. Hosmer-Lemeshow goodness-of-fit test, concordance statistic, and Brier score were used to assess the calibration, discrimination, and accuracy of the models, respectively. RESULTS: Of the 1152 patients (1743 breasts) reviewed, 855 patients (1333 breasts) had complete data for BRA-score calculations and were included for analysis. Hosmer-Lemeshow tests for calibration demonstrated a good agreement between observed and predicted outcomes for surgical site infection (SSI) and seroma models (P-values of 0.33 and 0.16, respectively). In contrast, predicted rates of explantation deviated from observed rates (Hosmer-Lemeshow P-value of 0.04). C statistics demonstrated good discrimination for SSI, seroma, and explantation (0.73, 0.69, and 0.78, respectively). CONCLUSIONS: In this external validation study, the BRA Score tissue expander/implant reconstruction models performed with generally good calibration, discrimination, and accuracy. Some weaknesses in certain models were identified as targets for future improvement. Taken together, these analyses validate the clinical utility of the BRA score risk models in predicting 30-day outcomes.
[Mh] Termos MeSH primário: Remoção de Dispositivo
Mamoplastia/efeitos adversos
Modelos Estatísticos
Seroma/etiologia
Infecção da Ferida Cirúrgica/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Previsões
Seres Humanos
Meia-Idade
Medição de Risco/métodos
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE



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