OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer. METHODS: A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups. RESULTS: In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group (P<0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups (P<0.05, P<0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group (P<0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups (P>0.05). CONCLUSION TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.
Humans ; Female ; Acupuncture Points ; Pain, Postoperative/blood* ; Middle Aged ; Breast Neoplasms/surgery* ; Adult ; Transcutaneous Electric Nerve Stimulation ; Mastectomy, Modified Radical/adverse effects* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Interleukin-10/blood* ; Aged

OBJECTIVETo investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.

METHODSForty patients were randomly divided into two groups: the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan (20 cases) and control group with chemotherapy alone (20 cases). The same chemotherapy was given to the two groups. All the 40 patients had no contraindication for carvedilol and candesartan. Patients of the experimental group received low-dose carvedilol from 2.5 mg orally twice a day at first cycle to 5 mg twice a day gradually if no side reactions, and candesartan 2.5 mg orally once a day. Electrocardiogram, ultrasonic cardiogram, arrhythmia, troponin and non-hematologic toxicity were recorded and compared after the second, forth and sixth cycle of chemotherapy. Each cycle included 21 days.

RESULTSLVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group. LVEDD and LVESD showed no significant changes in the experimental group, but gradually increased in the control group. After four and six cycles of chemotherapy, LVEF were (57.00 ± 5.13)% and (45.95 ± 3.68)%, respectively, in the control group, significantly lower than that of (67.00 ± 5.13)% and (57.50 ± 2.57)%, respectively, in the experimental group (P < 0.05). After six cycles of chemotherapy, LVEDD and LVESD were (50.00 ± 10.48) mm and (35.01 ± 2.99) mm, respectively, in the control group, significantly higher than those before chemotherapy (P < 0.05) and experimental group (P < 0.001). The rate of ST segment and T wave abnormalities was 80.0% in the control group after six cycles of chemotherapy, significantly higher than that of 25.0% after four cycles of chemotherapy (P = 0.001) and 10.0% after two cycles of chemotherapy (P < 0.001). The reduction of QRS voltage, arrhythmia and abnormal troponin were 55.0%, 45.0% and 45.0%, respectively, in the control group, significantly higher than those in the experimental group (20.0%, P < 0.05), (10.0%, P = 0.010) and (10.0%, P < 0.05), respectively. The rate of abnormal expression of troponin was 45.0% in the control group, significantly higher than the 10.0% in the experimental group (P < 0.05).

CONCLUSIONSThe use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs, and with tolerable toxicities. This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.

Adrenergic beta-Antagonists ; administration & dosage ; pharmacology ; Adult ; Aged ; Angiotensin II Type 1 Receptor Blockers ; administration & dosage ; pharmacology ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Arrhythmias, Cardiac ; chemically induced ; Benzimidazoles ; administration & dosage ; pharmacology ; Breast Neoplasms ; drug therapy ; surgery ; Carbazoles ; administration & dosage ; pharmacology ; Chemotherapy, Adjuvant ; Cyclophosphamide ; adverse effects ; therapeutic use ; Electrocardiography ; drug effects ; Epirubicin ; adverse effects ; therapeutic use ; Female ; Fluorouracil ; adverse effects ; therapeutic use ; Humans ; Mastectomy, Radical ; Middle Aged ; Propanolamines ; administration & dosage ; pharmacology ; Stroke Volume ; drug effects ; Tetrazoles ; administration & dosage ; pharmacology ; Troponin ; metabolism

OBJECTIVETo observe the regulatory effect of transcutaneous electro-acupuncture (TCEA) for preventing intratracheal extubation stress response (IESR) in general anesthesia.

METHODSSixty patients with breast cancer scheduled to receive mastectomy were numbered according to their sequence of hospitalization, patients of odd number were assigned to the control group and those of even number to the treated group, 30 in each group. They were anesthetized by the same anesthesia approach, but TCEA was applied on patients in the treated group in the narcotic process by stimulating at Hegu (LI4) and Neiguan (PC6) of the diseased side for 20 min before induction; then on bilateral points of Hegu, Neiguan, Chize (LU5) and Lieque (LU7) all through the whole course of operation, but at time of 30 min before ending operation, stimulus at Chize and Lieque points stopped and turned to bilateral Shuitu (ST10) and Qishe (ST11) points. No management other than conventional anesthesia was applied on patients in the control group. Changes of blood pressure (MAP), heart rate (HR), plasma catecholamine and cortisol as well as the respiratory tract response occurred after extubation were observed and compared.

RESULTSHR, MAP, plasma levels of catecholamine and cortisol increased after extubation in both groups (P < 0.05), but the changes were more obvious in the control group than in the treated group (P < 0.05). Besides, the adverse reaction of respiratory tract occurred in the treated group was milder (P < 0.05).

CONCLUSIONSTCEA can alleviate the IESR to attenuate the adverse reaction of respiratory tract. It is definitely valuable in clinical practice.

Acupuncture Points ; Airway Extubation ; Anesthetics, General ; adverse effects ; Breast Neoplasms ; surgery ; Electroacupuncture ; methods ; Female ; Humans ; Mastectomy, Modified Radical ; Stress, Physiological ; Transcutaneous Electric Nerve Stimulation ; methods

Adult ; Aged ; Axilla ; innervation ; surgery ; Brachial Plexus ; surgery ; Breast Neoplasms ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Mastectomy, Radical ; adverse effects ; methods ; Middle Aged ; Pain, Postoperative ; etiology ; Somatosensory Disorders ; etiology

OBJECTIVETo investigate a new surgical method to treat unilateral limb lymphedem after radical mastectomy.

METHODS10 cases of upper limb lymphedema after radical mastectomy were treated using flap transfer (the lateral thoracic skin flap or latissimus dorsi musculocutaneous flap combined with liposuction).

RESULTSAfter the treatment, the upper limb perimeter reduced in varied degrees. Nuclear lymphatic radiography showed notable changes in lymphatic circulation. The effective results were steady during the follow-up of 3-18 months.

CONCLUSIONFlap transplantation combined with liposuction is a useful treatment for limb lymphedema from radical mastectomy.

Breast Neoplasms ; surgery ; Female ; Humans ; Lipectomy ; Lymphedema ; etiology ; surgery ; Mastectomy, Radical ; adverse effects ; Postoperative Complications ; surgery ; Surgical Flaps

Several months after left radical mastectomy without irradiation therapy for breast cancer, a 74-year-old woman developed severe edema on the homolateral arm extending to the axilla. Ten years later, purplish to brownish blotch and nodules accompanied with heating sensation and pain appeared and increased in size gradually on the left forearm. The patient was treated by irradiation therapy under the clinical and histopathologic diagnosis of Stewart-Treves syndrome and almost all of the skin lesions and symptoms disappeared after irradiation of 6450 rads.
Aged ; Arm ; Breast Neoplasms/*surgery ; Female ; Hemangiosarcoma/*etiology/pathology/radiotherapy ; Humans ; Lymphedema/*complications ; Mastectomy, Radical/*adverse effects ; Skin Neoplasms/*etiology/pathology/radiotherapy