THE BREAST RECONSTRUCTION PROCESS OF WOMEN WITH BREAST CANCER: A THEORETICAL MODEL

ABSTRACT Objective: to build a theoretical model on the experience and meaning of the breast reconstruction process in women with breast cancer. Method: a qualitative research using Grounded Theory and Symbolic Interactionism as theoretical-methodological frameworks. Data collection and analysis occurred simultaneously, from April to October 2015, through theoretical sampling and theoretical saturation of the categories. Theoretical sample with 31 participants, 21 women and 10 health professionals, interviewed at home or at work, comprising four sample groups. Results: the theoretical model “Women face challenges and overcome difficulties: fear of death, breast mutilation and breast reconstruction, changing the way of being a woman” offers an explanation of the phenomenon and emerged from the systematic interrelation of the 11 study categories, with three causal categories, one category representing the context, five categories of intervening conditions, the strategies and the consequences represented by one category each. Conclusion: this study demonstrates the experience of the breast reconstruction process for women with breast cancer, the meaning of overcoming difficulties, value life and oneself, putting themselves first, taking care of themselves and learning to change, to be more tolerant, to value material things less and to face life with courage and faith. It also indicates that research on theoretical models on issues that plague our professional practices can enhance teaching and science and, consequently, improve care in women's health.

BREAST RECONSTRUCTION FROM THE PERSPECTIVE OF WOMEN SUBMITTED TO MASTECTOMY: A META-ETNOGRAPHY

ABSTRACT Objective: to analyze qualitative studies published in the national and international scientific literature on breast reconstruction after mastectomy for breast cancer, from the perspective of women. Method: systematic literature review using meta-ethnography, where the synthesis of knowledge is based on the induction and interpretation of the data found. Searches in the electronic databases identified 65 studies. 27 studides meet the inclusion and exclusion criteria. 13 studies compressed the analytical corpus of the review, according to the Critical Appraisal Skills Programme checklist. The data were synthesized by means of the meta-ethnographic approach. Results: the analyzed studies showed similarities regarding the women´s decision to perform breast reconstruction, the difficulty of choosing the type of surgery and to deal with the experience of the reconstruction, and that the women had difficulties in establishing relationships with certain health professionals, especially with doctors. They refer to the ambivalence of feelings regarding the expectations and results of breast reconstruction and complex process of "carrying on". Conclusion: this review synthesizes the scientific knowledge regarding women's perspective regarding the breast reconstruction process and highlights that health professionals must understand the perceptions of women undergoing mastectomy and breast reconstruction in order to improve the care provided.

[Female urinary incontinence: a systematic review of qualitative studies]

Urinary incontinence has broad repercussions on female daily life. The objective of this study was to conduct a systematic review seeking to analyze results of qualitative research concerning female urinary incontinence published prior to 2009. After an electronic search, 53 research reports were identified with 30 fulfilling the exclusion and inclusion criteria. After classification according to the Critical Appraisal Skills Program, 13 constituted the analytical body for review. The data were synthesized according to the meta-ethnographical approach through reciprocal translation. Two categories emerged: life experiences among incontinent women; and proposals for care models for incontinent women. The restructuring of one's personal life metacategory points to individual adjustments necessary for dealing with the problem. In essence, the results reveal the option of the majority of women facing the loss of urine "silently" and point to the need for professionals to understand family perceptions in order to better comprehend the personal, family, and social implications involved in female urinary incontinence.

Brazilian scientific publications of obstetrical nurses on home delivery: systematic literature review

This review study of national journals aimed at characterizing the scientific production of Brazilian nurses regarding home delivery and identifying the results achieved. A total of 27 studies were found, of which ten studies complied with the inclusion criteria, with eight constituting the analytical corpus in accordance with the Critical Appraisal Skills Program. Data were synthesized using the meta-ethnographic approach, following the interpretation of the reciprocal translation. Three categories emerged: The care provided by traditional midwives; Experiences of women cared for by health professionals in a home delivery; and Comparative experiences of women who experienced deliveries both at home and in a hospital. The metacategory 'respectful delivery in the embracing home environment' points to the need to assess the reality of the Brazilian home delivery. Results reveal the practice of traditional midwives and the satisfaction of women who delivered their child at home, and reveal an important gap regarding the production of knowledge of the obstetrical nurse regarding home delivery.

[Partial sphincterectomy in cataract surgery. Clinical and patho-histologic results]

BACKGROUND

We perform partial sphincterectomy during cataract surgery in cases with very small pupil (< 3 mm). We assume that the small pupil is mainly due to a fibrosis ring of the sphincter muscle.

PATIENTS

In 35 patients we performed the complete ophthalmological routine checkup. The pupil diameter was analysed by perimeter: a base value, with light, and in pharmaceutical mydriasis. Moreover 15 preparations were analysed histologically.

RESULTS

Average pupil diameter was: base value 3.76 mm, with light 3.24 mm, in pharmaceutical mydriasis 4.84 mm. The showed pathohistological examination that in all excisions a part of the sphincter muscle was verifiable. We found fibrosis of different grades in various locations.

CONCLUSION

In most cases functional pupil movement can be verified after operation. In an intended partial sphincterectomy part of the sphincter muscle can be excised. The different pupil diameter is due to the different degree of fibrosis of the sphincter muscle.

[Cataract surgery in narrow pupil and postoperative fibrin reaction, especially after sphincterectomy]

BACKGROUND

Since increased intraoperative iris irritation can lead to increased postoperative inflammation, we are interested in postoperative reactions to several varied surgical procedures. We performed pupil stretching, iridotomy with iris suture, and partial sphincterectomy.

MATERIALS AND METHODS

From January 1995 to January 1996, 100 patients (103 eyes) with narrow pupils underwent cataract surgery. In 13 eyes a iridotomy and iris suture were performed, in 28 eyes a partial sphincterectomy. In 62 eyes there was no surgical intervention after pupil stretching. Postoperative examinations were carried out in the early postoperative phase (up to 5 days postoperative) as well as 4 weeks after surgery. Fibrin reaction was classified according to 3 grades, (1) faint fibrinous threads, (II) fibrinous net, and (III) membranous fibrin exsudation.

RESULTS

In the group without additional surgery there was a fibrinous reaction of grade I and II in 11 eyes. This complication occurred after iridotomy and iris suture in four cases and after sphincterectomy in four cases. While the intensity of fibrinous reaction was comparable in the first two groups, the fibrinous reaction after sphincterectomy was more intensive in one eye (grade III). However, response to intensive local antiphlogistic therapy was good. Frequency of fibrinous reaction in the three groups was statistically not significant. It should be pointed out that there was a partial restoration of pupil movements through sphincterectomy: mean pupil diameter was 4 mm, and 2.5 mm under exposure to light. Three patients had no pupillary reaction at all.

CONCLUSIONS

Partial sphincterectomy facilities intraoperative manipulations of cataract surgery. Postoperative inflammatory reaction is rare and was very responsive to medical treatment. The reconstruction of pupillary movement is part of full visual function and, last but not least a round pupil is aesthetically more desirable.

[Minimizing astigmatism by controlled localization of cataract approach with the no stitch technique. A prospective study]

BACKGROUND

The no-stitch-technique with deliberate localisation of the cataract incision is a method to reduce the postoperative astigmatism. This prompted us to investigate the postoperative astigmatism with varying incision localisation; our aim is to achieve a postoperative astigmatism < or = 1.0 D.

PATIENTS AND METHOD

In this study we controlled 319 eyes of 316 cataract patients. We took into consideration the preoperative astigmatism and operated in the 12 o'clock or lateral position. The astigmatism was measured by an ophthalmometer preoperatively, on the first day, after 3-5 months and 8-12 months after surgery.

RESULTS

A preoperative astigmatism of up to < or = 1.0 D was present in 82.4% of eyes. On the first day after surgery an astigmatism of < or = 1.0 D was present in 89.3% of eyes. After 3-5 months postoperatively astigmatism was < or = 1.0 D in 97.2% and in 98.8% after 8-12 months postoperatively. 15.7% of patients showed a preoperative astigmatism between 1 and 2 D, but only 1.2% after 8-12 months. There was no astigmatism > 2.0 D after 3-5 months and 8-12 months (preoperative 2%).

CONCLUSIONS

The no-stitch-technique permits to control the postoperative astigmatism with deliberate localisation of the cataract incision. Postoperative astigmatism appeared to be stable. We therefore recommend for preoperative "ATR (Against the rule)-Astigmatism" (> or = 1.0 D) operation in lateral position and for preoperative "WTR (With the rule)-Astigmatism" operation in the 12 o'clock position.

Metabolism of trinitrobenzene sulfonic acid by the rat colon produces reactive oxygen species

Recent studies have shown that intrarectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) in ethanol or intramural injection of TNBS in saline produces an acute and possibly chronic colitis in rats. It has been assumed that interstitial TNBS initiates the inflammatory response via macrophage-mediated recognition and degradation of TNBS-modified mucosal cells and proteins. However, it is known that certain flavoproteins and/or reductants interact with compounds containing the nitro functional group to generate pro-inflammatory, nitrogen-centered free radicals and reactive oxygen metabolites. The objective of this study was to assess the ability of the rat colon, using either colon homogenates, isolated colonocytes, or intestinal interstitial fluid, to produce reactive oxygen species via enzymatic and/or nonenzymatic metabolism of TNBS. It was found that the addition of TNBS (1 mmol/L) to the 10,000 x g supernatant of rat colon homogenates increased the rate of superoxide production from normally undetectable levels to 2.6 +/- 0.23 nmol.min-1.mg protein-1. Addition of nicotinamide adenine dinucleotide, reduced form (NADH; 1 mmol/L) to colon homogenates containing TNBS significantly enhanced superoxide production to 10.4 +/- 0.9 nmol.min-1.mg-1. Similarly, addition of nicotinamide adenine dinucleotide phosphate, reduced form (NADPH; 1 mmol/L) to colon extracts containing TNBS produced an even further increase in the rate of superoxide formation to 25.2 +/- 1.1 nmol.min-1.mg-1. Addition of NADH or NADPH to the colon homogenate in the absence of TNBS produced no detectable superoxide formation, suggesting that TNBS was required for the enhanced oxidative metabolism. In a separate series of experiments, it was found that isolated colonocytes produced small but significant amounts of superoxide (3.15 +/- 0.6 nmol/2 x 10(6) cells) that were significantly increased in the presence of ethanol to 6.55 +/- 1.14 nmol/2 x 10(6) cells. Using purified preparations of two flavoproteins found in the rat colon, it was shown that the addition of TNBS (1 mmol/L) to purified NADH dehydrogenase or glutathione reductase increased the rate of superoxide formation by these enzymes from normally undetectable levels to 1.6 nmol/min and 1.2 nmol/min, respectively. In addition, it was found that intestinal interstitial fluid (lymph) initiated redox cycling of TNBS such that 28.1 +/- 1.6 nmol of oxygen was consumed per minute per milliliter of lymph. This increase in oxygen consumption was inhibited by the addition of superoxide dismutase and catalase. One possible metabolite involved in both mucosal and lymph-mediated metabolism of TNBS is ascorbic acid.(ABSTRACT TRUNCATED AT 400 WORDS)

The effects of sulfasalazine metabolites on hemoglobin-catalyzed lipid peroxidation

Ulcerative colitis (UC) is a recurrent inflammation of the colon and rectum that is characterized by subepithelial hemorrhage, epithelial cell necrosis, infiltration of large numbers of phagocytic leukocytes (neutrophils, eosinophils, macrophages), and mucosal ulcerations. Recent evidence suggests that mucosal lipid peroxidation may play an important role in that pathogenesis of the inflammation-induced intestinal injury. Using hemoglobin (Hb)-catalyzed, H2O2-dependent peroxidation of phospholipid as a model of oxidative injury to membrane lipids, we assessed the ability of the anti-inflammatory drugs sulfasalazine (SAZ), olsalazine, and their metabolites, 5-aminosalicylic acid (5-ASA), N-acetyl-5-ASA, and sulfapyridine (SP) to inhibit this reaction. We found that Hb interacted with H2O2 to yield the radical and nonradical forms of ferryl Hb (Hb(V)) which were capable of initiating the peroxidation of a phospholipid. This interaction did not result in the peroxide-dependent release of iron from the hemoprotein. In addition, we demonstrated that the pharmacologically active moiety of SAZ (or olsalazine), 5-ASA, was significantly better at inhibiting the Hb-catalyzed peroxidative reaction. The concentration of 5-ASA required to inhibit lipid peroxidation by 50% (IC50) was determined to be 50 microM. Neither parent compound (SAZ, olsalazine) nor the pharmacologically inactive metabolite (SP) were effective in attenuating the lipid peroxidation at concentrations up to 100 microM. The N-acetylated derivative of 5-ASA was less effective as an inhibitor in this system possessing an IC50 of 100 microM. The mechanism by which 5-ASA inhibited lipid peroxidation appeared to be due to its ability to donate electrons to and thus scavenge the radical and nonradical forms of HB(IV).(ABSTRACT TRUNCATED AT 250 WORDS)