Postmastectomy Syndrome Research Articles

Methods of Controlling Postoperative Complications after Lymphadenectomy in Patients with Breast Cancer

Introduction. Reducing the aggressiveness of surgical tactics is currently considered a promising trend in medicine that is widely supported due to its better safety profile. However, a large percentage of patients need more intervention. In the treatment of breast cancer, the main difficulties in postoperative management are associated with lymphatic surgery. Aim. To perform a comparative analysis of techniques for intraoperative control of lymphorrhea in patients during lymph node dissection for breast cancer in Yaroslavl Regional Oncologic Hospital. Materials and methods. Case histories of 660 patients after axillary subclavian subscapular lymphadenectomy were analyzed. In the postoperative period, patients revealed prolonged lymphorrhea. Magnifying techniques (binocular lenses, microscope) were used during the interventions to detect and isolate lymphatic vessels in 108 patients. A double coagulation technique was used to ligate the lymphatic vessels. Sufficient coagulation surface was achieved by forming suture lines of an angle greater than 90°. When performing a mastectomy, the technique was supplemented by circular bandaging of the chest. Results and discussion. Analysis of case histories showed that lymphadenectomy proved to be the main significant factor influencing lymphorrhea. Sparing techniques reduced the risk of postmastectomy syndrome. Comparing the study group with the control group revealed a statistically significant reduction in the severity of lymphorrhea without an increase in the risk of other complications. Conclusion. The combination of these techniques demonstrated statistically significant advantages in controlling postoperative complications. The techniques are easy to perform, therefore, they can be introduced into practice with minimal costs. The economic benefits are associated with the absence of additional costs for surgery, as well as with a reduction in the duration of hospital stay for patients. All this significantly increases patient satisfaction with the treatment performed.

SURGICAL METHODS OF PREVENTION OF POST-MASTECTOMY SYNDROME: A LITERATURE REVIEW

Relevance: Despite improvements in early diagnosis, breast cancer continues to be one of the most common types of malignant tumors in the Republic of Kazakhstan, affecting about 5,000 women annually. Surgery remains the main method of treatment for breast cancer. Rapid development and improvement of various methods and devices for reconstructive plastic surgery plays an important role in the medical, psychological, and social rehabilitation of patients with breast cancer, allowing to achieve better aesthetic and functional results. Postmastectomy syndrome (PMPS) is a complex complication of surgical tumor resection and affects almost half of women who have undergone this intervention. The study aimed to analyze surgical methods for the prevention of postmastectomy syndrome to improve the outcomes, the course of the postoperative period and the quality of life of patients. Methods: Data from MEDLINE, Embase, Scopus, PubMed, and Cochrane Central Register of Controlled Trials were analyzed to select and analyze relevant information over the past 10 years using the keywords: “postmastectomy syndrome,” “mastectomy,” “lymphedema,” “brachioplexitis.” Results: The literature analysis showed that treating PMS requires a comprehensive approach, since the manifestations of PMS may vary depending on individual characteristics, the extent of surgical intervention, and other individual factors. The effectiveness of the interventions varied, with some showing promising results in reducing pain intensity, while others demonstrated improvements in functional outcomes and quality of life. Thus, it was found that ultrasound dissection is superior to electrocoagulation in terms of intraoperative blood loss, amount of lymphorrhea, and average hospital stay. Lymphatic-venous anastomoses are difficult to reproduce, but have been reported to be 95% effective in preventing lymphedema. Autologous fat tissue transplantation solves several problems, including reducing chronic pain syndrome (>6 months) by 3.1 points. Brachioplexitis and associated complications can be prevented during surgery. Conclusions: Given the variability of PMS complications, it is advisable to prevent the burden and financial costs of rehabilitation in the postoperative period. Surgical methods of prevention discussed in this literature review can be used intraoperatively to significantly reduce the risk of PMS.

Options to apply national developments in the assessment of sentinel lymph node involvement in breast cancer

Background. Breast cancer is the leading oncopathology of women. The routine radical surgery performed in this pathology includes lymph node dissection, which provokes development of postmastectomy syndrome. However, the removal of non-metastatic lymph nodes is not rational according to the subsequent disability of the patients. This can be avoided by using a sentinel lymph node (SLN) biopsy procedure. At this stage of oncology development, there are several ways to visualize SLN. The fluorescent method is among the most promising. This technique has been used for many years. However, it is not sufficiently implemented in clinical practice. There are still several questions about the procedure for its performance. In addition, it requires the introduction and improvement of domestic developments, including reducing financial costs.Aim. To study the use of indocyanine green of domestic production (LLC Firm “FERMENT”, Russia) and the IC-GOR detection system (LLC “MedKomplekt”, Russia) for SLN biopsy in patients with early breast cancer.Materials and methods. From February to September 2023, biopsy of SLN using indocyanine green (LLC Firm “FERMENT”, Russia) was performed in 53 patients with early breast cancer without clinically detectable lesion of regional lymph nodes. In all cases, according to the clinical examination, the patients had an operable stage of breast cancer (cT1–3N0M0). 5 mg of indocyanine green, dissolved in 4 ml of water for injection, was administered after sanitizing of the surgical field intradermally and subcutaneously at 2 points in the upper-outer quadrant of the breast along the edge of the areola in 40 patients (75.5 %) or paratumorally in 13 patients (24.5 %). An incision in the axilla about 4 cm long was made no earlier than 10–15 minutes after injection of indocyanine green (when visualizing the track 1 cm beyond its distal end to avoid crossing the lymph duct, after which the drug can flow into the wound). After imaging, all detected lymph nodes were removed for planned morphological examination. Standard lymph node dissection of 1 and 2 level was performed in all patients. Middle age of patients was 64.5 years (from 37 to 85 year). In 40 patients (75.5 %) modified radical mastectomy was performed, breast conserving surgery was done in 13 cases (24.5 %).Results. SLN were visualized in 51 patients out of 53 (96.2 %). After the final morphological examination, the majority of patients in the group were ranged in the IA and IIA stages of the disease – 15 (28.3 %) and 28 (52.8 %), respectively. Metastasis in the SLN were found in 9 patients (17.0 %). Besides, in 3 cases (5.7 %) metastasis in the lymph nodes were found after lymph node dissection. In 4 cases (7.6 %) metastasis were found during lymph node dissection but were not detected in the removed SLN. Thus, in the study group 13 (24.5 %) patients had metastatic lymph node lesion despite negative clinical status. The total number of removed SLN in the study group was 169 (from 1 to 6), the average number of removed lymph nodes was 3.3. Any negative events, allergic and general reactions to indocyanine were not reported.Conclusion. Our technique of contrasting SLN with indocyanine green is adequate and reproducible. The frequency of detection of SLN with this method is 96.2 %, with an acceptable level of false negative results is 7.6 %. Indocyanine green (LLC Firm “FERMENT”, Russia) and the LED fluoroscopic cancer detector IC-GOR (LLC “MedKomplekt”, Russia) can be recommended for performing a SLN biopsy.

Bioimpedance and upper limb lymphedema index in the diagnosis of lymphedema in post-mastectomy syndrome

Methods for assessing post-mastectomy edema: bioimpedance and upper extremity lymphedema index (UEL index) are non-invasive, highly sensitive and easily feasible diagnostic methods, suitable for predicting the prospects of surgical treatment and analyzing the dynamics of edema. The purpose of the study was to study UEL index indicators and bioimpedance data at different stages of upper extremity lymphedema. Material and methods. The study included 64 patients with post-mastectomy edema who underwent bioimpedance, measurement of the circumference of the upper extremity and calculation of the UEL index. Results. The upper extremity lymphedema index and bioimpedance parameters (fluid volume in the limb and the ratio of extracellular fluid to total fluid volume) characterizing the liquid component significantly increased at stages II and III of lymphedema in comparison with the control group. a statistically significant correlation was revealed between the upper limb lymphedema index and bioimpedance parameters (R=0.41) and (R=0.49), respectively. Conclusion. Bioimpedance parameters and values of the upper extremity lymphedema index can be interchangeable. The reliability and high sensitivity of these methods for assessing post-mastectomy edema allows us to obtain quantitative criteria for evaluating the liquid component at different stages of lymphedema.

The sociological assessment of psycho-emotional status after mastectomy as one of main indicators of life quality of women with breast cancer: ways of correction

The psycho-emotional status of women after radical surgery for breast cancer was assessed. The international questionnaire FACT-G and module FACT-B module were applied to investigate life quality of 186 women under dispensary monitoring concerning breast cancer of stage I-II. The respondents were aged 30-40, 41-50, 51-60, 61-70 and 71 years and older. In women who underwent radical surgery for breast cancer, psycho-emotional status is manifested most vividly as compared with other perceptions in the postoperative period and decreases quality of life. The overwhelming majority of women with breast removal experiences feeling of inferiority and depression, despair, fear of health deterioration and death that increase with age. The percentage of women satisfied with their coping with illness is 64.8% among 30-41 years old, 45.8% among 51-60 years old and 4.2% among 70 years and older. The impact of stress on disease is most felt in women of 51-60 years old (63,6%) and 61-70 years old (58,8%). No reliable differences in level of emotional condition of urban and rural respondents was established. The attitude of women to methods of postoperative correction through formation of breast lost depends on their age, place of residence, level of education. More than 60% of respondents under age of 50 years consider solution of aesthetic problem in endoprosthesis replacement with implants. Among respondents aged 51-60 years, 25.0% preferred simultaneous mastectomy and breast reconstruction and 10.1% - breast plastic surgery. The endoprosthesis replacement is more often resorted by women older 60 years and rural residents. The choice of mode of breast correction often depends on financial possibilities of patients. The study of quality of life of women with post-mastectomy syndrome is valuable component of integrated approach to dispensary monitoring that individualizes rehabilitation measures. The effectiveness of psychological rehabilitation of women requires involvement of clinical psychologists and medical social services.

Influence of cardiorespiratory training program on the intercellular adhesion molecule level in patients with postmastectomy syndrome

To evaluate the influence of 12-week aerobic dynamic training program of moderate intensity on the endothelial dysfunction laboratory markers and life quality in patients with PMS. Single-center prospective randomized trial included 40 patients with PMS divided into study (20 patients) and comparative (20 patients) groups, as well as 20 healthy female volunteers. The expression level of soluble intercellular adhesion molecule-1 (ICAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) were evaluated in all participants at baseline by enzyme-linked immunosorbent assay method, and additionally psychological and physical component of health by SF-36 questionnaire were assessed in patients with PMS. The group of patients with PMS after BC treatment had increased level of ICAM-1 in long-term period, that may indicate endothelial dysfunction. Statistically significant decrease of endothelial dysfunction laboratory markers was revealed in patients with PMS, who underwent the course of cardiorespiratory training. In the same time, the dynamics of changes in ICAM-1 was higher in the study group than in comparative group. Further, improvement of physical and psychological components of health by SF-36 questionnaire was found. The program of cardiorespiratory trainings of moderate intensity in patients, who had BC treatment a year ago, decreases intercellular adhesion molecules level that may show an improvement of endothelial dysfunction.

Postoperative Chronic Pain Syndrome and Risk Factors in Patients with Breast Surgery.

To investigate the incidence of chronic postoperative pain after different types of breast surgery, and investigate the risk factors associated with chronic postoperative pain. Descriptive study. Place and Duration of the Study: Ankara University, Faculty of Medicine, Ibnisina Hospital, from January to May 2021. Postoperative chronic pain syndrome and risk factors were investigated in 200 female patients who underwent breast surgery for different reasons. The relationships between preoperative chronic pain, analgesic drug use, number of previous surgeries, anxiety, depression levels, lifestyle, age, height, body mass index, education level, postoperative acute pain, and postoperative sixth-month pain level were statistically analysed. Chronic postoperative pain was observed at a rate of 30%. Postmastectomy syndrome was observed with a rate of 31.6%. A statistically significant relationship was found between preoperative chronic pain, smoking, analgesic use, and postoperative chronic pain (p<0.001). Total mastectomy, mastectomy and simultaneous reconstructive surgery, axillary surgery were associated with chronic pain (p<0.001). A strong correlation was observed between preoperative anxiety (r=0.758, p<0.001), depression (r=0.773, p<0.001), and chronic pain. Chronic postoperative pain and postmastectomy pain syndrome are found in almost one-third of the operated patients mainly related to preoperative smoking, analgesic use, breast cancer, and psychological state. Chronic pain, Breast neoplasms, Mastectomy, Anxiety, Depression.

Clinical and neuroimaging laboratory possibilities of diagnostics of vestibulo-atactic syndrome in patients with postmastectomic syndrome

Background. In recent years, the prognosis of survival after treatment for breast cancer (BC) has improved significantly, leading to an increase in the life expectancy of patients and the incidence of long-term side effects of therapy. reducing the risks of complications and developing a unified algorithm for diagnosing cerebral complications are necessary to improve the quality of life of patients.Objective. To correlate the CNS and endothelium damage biomarkers concentration and the functional connectivity of the brain in patients with newly diagnosed vestibulo-atactic syndrome (VAS) and without it in the late period of radical treatment of breast cancer.Design and methods. The study involved 21 patients with VAS in the late postoperative period after radical treatment of breast cancer, as well as a group of healthy volunteers — 17 people. Biomarkers were determined by ELISA. Functional MRI was performed.Results. An increase in markers of CNS damage and endothelial damage (ICAM, PECAM) was noted in patients with post-mastectomy syndrome (PMES) and VAS, compare with control group and PMES without VAS group. The processes of disorganization and the formation and strengthening of interand intrahemispheric connections were noted using fMRI.Conclusion. The development of novel diagnostics methods, including the use of fMRI and the determination of different biomarkers are promising for improvement of the VAS treatment effectiveness in patients with PMES.

Сerebrovascular disorders in patients with postmastectomy syndrome

The article is devoted to one of the manifestations of post-mastectomy syndrome - cerebrovascular disorders that develop in patients after radical treatment of breast cancer. The literature review considers the pathogenetic aspects of cerebrovascular disorders, clinical manifestations, methods of diagnosis and treatment of this pathology.

Surgical treatment of lymphedema of the upper extremities in patients with post-mastectomy syndrome

Surgical treatment of lymphedema of the upper extremities in patients with post-mastectomy syndrome

Comparison of the state of brain metabolism and psycho emotional disorders in patients with postmastectomy syndrome

BACKGROUND: The most common consequence of radical treatment of breast cancer is postmastectomy syndrome a complex of changes in the lymphocirculatory system, central and peripheral nervous system, skeletal and muscular apparatus, that significantly reduce the quality of life and working capacity of women. In recent years, special attention has been paid to the study of psycho emotional disorders in this group of patients. A promising method for preclinical diagnosis of anxiety and depressive disorders in patients with postmastectomy syndrome may be positron emission computed tomography with fluorine-18 labeled glucose 2(18F)-fluoro-2-deoxy-D-glucose, which makes it possible to deduce typical patterns of changes in glucose metabolism in cerebral structures in various depressive and anxiety states.&#x0D; AIM: The purpose of this study is to study the relationship between brain metabolism and psycho emotional status in patients with postmastectomy syndrome.&#x0D; MATERIALS AND METHODS: In our work, the sample consisted of 28 patients who underwent radical treatment for breast cancer, who underwent an assessment of the psycho-emotional state using the State-Trait Anxiety Inventory and Zung scales for self-assessment of depression. Positron emission tomography was also performed with 18-fluorodeoxyglucose.&#x0D; RESULTS: The study revealed that 71% of patients showed an increased level of anxiety, 64% showed signs of depression. Positron emission tomography data revealed the following areas of hypometabolism in patients with anxiety-depressive disorders: parietal cortex, inferior parietal lobule, precuneus, superior temporal gyrus, prefrontal cortex, posterior cingulate cortex.&#x0D; CONCLUSION: Thus, typical zones of changes in glucose metabolism in patients with psycho emotional disorders have been identified, which makes it possible to improve the accuracy of diagnosing these conditions, as well as to develop the most effective ways to prevent and treat them.

The role of sentinel lymph nodes in breast cancer

Introduction. The problem of improving early diagnosis and prognosis of breast cancer remains one of the most actual for current oncological practice. Taking into account a close correlation between the general prevalence of breast neoplasms and mortality from breast cancer, this problem is not only of professional interest, but also has medical-social and socio-economic significance.&#x0D; The purpose of the study is to improve the quality of the sentinel lymph node detection in patients with breast cancer using ICG.&#x0D; Material and methods. At the period 2009–2016, 400 patients with T1-T3N0M0 breast cancer were operated on. All the patients were divided into two groups using two dyes – Patent Blue and ICG. The patients after mastectomy with a sentinel lymph node biopsy had a clinical diagnosis of T2-T3N0M0 breast cancer more often.&#x0D; In group I, 100 patients had the sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye.&#x0D; In group II, sentinel lymph nodes biopsy was conducted with the Patent Blue dye and another fluorescent dye — ICG, which was also injected on the affected side of the breast. After ICG dye introduction, in 15 minutes the stained green lymph nodes were detected using special equipment.&#x0D; Criteria for inclusion of patients in the clinical trial:&#x0D; 1) breast cancer patients of any age with T1-3N0M0, I-II AB disease stage;&#x0D; 2) patients with clinically unaffected lymph nodes N0 after examination.&#x0D; Criteria for exclusion of patients from the clinical trial:&#x0D; The exceptions were T3-T4 tumors &gt; 5 cm in diameter, or the skin and chest wall invasion, as well as palpable axillary lymph nodes, 3 or more affected lymph nodes with sentinel lymph node biopsy;&#x0D; 3) patients after radiation therapy.&#x0D; Results. The tumor histology was performed after the node trephine biopsy. The main aims of sentinel nodes detection were staging and improving the breast cancer patients’ life quality after surgical treatment. The post-mastectomy syndrome, the main manifestation of which is swelling of the upper extremity is a big problem for patients because it affects their life quality and disturbs their usual lifestyle. The sentinel lymph node detection, in contrast to axillary lymph node dissection of I-II level, significantly minimizes all the risks of postmastectomy syndrome, in particular, impaired lymphatic drainage in the form of lymphatic edema of the upper extremity, impaired venous outflow in the form of stenoses or the axillary and/or subclavian veins occlusion, rough scars which limit the function of the extremity in the shoulder joint, and brachioplexitis.&#x0D; Conclusions. The study of sentinel lymph nodes significantly improves the results of surgical treatment of breast cancer patients. Based on the clinical-laboratory and histological examinations, new data were obtained concerning the sentinel lymph node detection using two dyes, the choice of the surgical intervention volume and reduction of complications rate at the postoperative period. We found that fluorescent lymphography is highly effective, which allows to recommend it for implementation into the clinical practice. The frequency of sentinel lymph node detection in breast cancer patients is 98% in the control group, 100% – in the main group.&#x0D; On the basis of the obtained results, the sentinel lymph node detection algorithm and the surgical management of patients with breast cancer was developed and implemented into practice, which allowed to reduce the number of complications with using two dyes for the sentinel lymph node detection from 19% to 2% (χ2 =15.37, p&lt;0.001). Recurrence of breast cancer fell from 13% to 8%.

Clinical and neuropsychological assessment of the condition of patients with post-mastectomy syndrome

Background. Post-mastectomy syndrome is a complex of symptoms that occurs in at least 80 % of women after treatment for breast cancer. The analysis of neurological disorders occurring in patients after antitumor treatment will increase the effectiveness of rehabilitation measures.Objective. To perform a clinical and neuropsychological assessment of the condition of patients with post-mastectomy syndrome.Design and methods. An open single-center uncontrolled study of the assessment of clinical and neuropsychological status in 45 patients with post-mastectomy syndrome was performed.Results. The components of the post-mastectomy syndrome are described, which, along with lymphedema of the upper limb, have a negative impact on the general health condition of the patients, lead to a violation of the psychosocial status, impaired adaptation and decreased life quality. In the clinical picture, a disorder of motor functions with a decrease in muscle tone, muscle strength, restriction of movements in the shoulder joint on the side of the operation, a violation of surface sensitivity on the medial surface of the shoulder was revealed.Conclusion. Studied patients developed anterior scalenus muscle syndrome (thoracic outlet syndrome), in the clinical picture manifested by pain, swelling, paresthesia and numbness of the upper limb on the side of the operation. Cerebrovascular disorders were manifested by vertebro-basilar insufficiency syndrome, which manifested in the form of headaches, dizziness, cognitive and emotional disorders.

Modern neuroimaging techniques in the assessment of changes in the brain connectome in patients with postmastectomy syndrome

Relevance. Currently, neuropsychiatric disorders are considered one of the main ones in the pathogenesis of postmastectomy syndrome. Modern neuroimaging techniques — functional (fMRI) and diffusion tensor (DTI) magnetic resonance imaging — allow us to identify functional and structural changes in the brain connectome in patients with postmastectomy syndrome caused by a complex of neuropsychiatric disorders.The purpose of the study. To evaluate changes in the functional and structural connectome of the brain in patients with postmastectomy syndrome using fMRI and DTI techniques.Materials and methods. The study was carried out on a tomograph with a magnetic field induction of 3.0 T. 46 patients with neurological disorders in the long-term postoperative period (more than 6 months) after radical mastectomy, chemotherapeutic and/or radiation treatment of breast cancer were examined.Results. According to the results of the intergroup statistical analysis, all 46 patients with postmastectomy syndrome had differences in functional connectivity in the default mode network and quantitative fractional anisotropy in the white matter tracts of the brain compared with the control group (p &lt; 0.01).Conclusion. The use of fMRI and DTI in patients with postmastectomy syndrome makes it possible to identify changes in the brain connectome correlating with neurological disorders and a decrease in the quality of life of patients. The results obtained will allow improving treatment and rehabilitation approaches in patients receiving treatment for breast cancer.

Changes in the structural connectom of the brain in patients with postmastectomy syndrome

Background. After breast cancer treatment, up to 90 % of patients suffer from various neurological and mental disorders, such as vertebrobasilar insufficiency, chronic pain syndrome, anxiety and depression. These disorders can cause structural changes in the white matter tracts of the brain, which can be detected using diffusion tensor magnetic resonance imaging (DT-MRI).Objective. To evaluate structural changes in the white matter tracts of the brain in patients with post-mastectomy syndrome using DT-MRI.Design and methods. The study was carried out on a tomograph with a magnetic field induction force of 3.0 T. 46 patients with neurological disorders in the long-term postoperative period (more than 6 months) after radical mastectomy, chemotherapeutic and/or radiation treatment for breast cancer were examined.Results. According to the results of an intergroup statistical analysis, all 46 patients with post-mastectomy syndrome had differences in quantitative fractional anisotropy in the white matter tracts of the brain compared with the control group (p &lt; 0.01).Conclusion. The use of DT-MRI in patients with post-mastectomy syndrome makes it possible to identify changes in the white matter tracts of the brain that correlate with neurological disorders and a decrease in the quality of life in this cohort of patients. The results obtained indicate the need to improve treatment and rehabilitation approaches in patients receiving treatment for breast cancer.

Changes in the microcirculatory bed in patients with post-mastectomy syndrome

The purpose of the study: to determine the features of the state of the microcirculatory bed in women with post-mastectomy syndrome as a cause of fibrosis.Material and methods. The study involved 76 women, of whom two groups were formed. The first group consisted of 46 patients aged 25 to 49 years (mean age – (43.8 ± 3.8) years old) with post-mastectomy syndrome (PMES), the average period after radicle treatment of breast cancer was (4.3 ± 2.1) years. All patients underwent mastectomy, radiation and chemotherapy for the treatment of breast cancer, followed by a comprehensive examination to exclude metastasis and continued tumor growth, as well as to exclude hemodynamically significant violations of venous and arterial blood flow of the upper extremities. The second group was formed of 30 healthy female volunteers aged 25 to 43 years, whose average age was (33.75 ± 10.70) years old. Clinical and instrumental methods of examination were used: anthropometric method, lymphoscintigraphy of the upper extremities, laser Doppler flowmetry, determination of the expression level of intercellular adhesion molecules sICAM-1, sPECAM-1.The results. Gross violations of the function of the microcirculatory bed were revealed: endothelial dysfunction, spasm of precapillary sphincters, decrease in the intensity of blood flow in the metabolic capillaries, the predominance of passive mechanisms of blood flow regulation. These changes lead to tissue hypoxia, which may be the trigger for the development of fibrosis and lymphedema. Endothelial dysfunction, which is confirmed by increased expression of specific biomarkers, may be the basis of these disorders. A complex, long-term change in the work of microvessels leads to a breakdown of compensatory mechanisms.Conclusion. The study of the pathogenetic mechanisms of the development of post-mastectomy syndrome will allow forming preventive strategies in patients after treatment of breast cancer, improving the quality of life of these patients. Further search for promising predictors of the development of fibrosis, the study of changes in the microcirculatory bed will provide additional information about the pathogenesis of PMES, to identify changes in the soft tissues of the upper extremities at an early stage of post-mastectomy syndrome, may be important for the development of more effective methods of treatment of PMES.

Functional MRI in the assessment of changes in the brain connectome in patients with post-mastectomy syndrome

Introduction. In the postoperative period after total mastectomy, patients develop postmastectomy syndrome, including upper limb lymphedema and a number of neuropsychiatric disorders that affect the functional state of the brain and reduce the quality of life.Purpose of the study. Evaluation of changes in functional connectivity of the default mode network in patients with post-mastectomy syndrome using resting state functional MRI.Materials and methods. Resting state functional MRI was performed to 46 patients aged 30 to 50 years with neurological disorders in the late postoperative period (&gt;6 months) after radical mastectomy for breast cancer, as well as 20 healthy women from the control group.Results. According to the intergroup statistical analysis, there were differences in functional connectivity of the default mode network in all 46 patients with post-mastectomy syndrome, compared to the control group (p&lt;0,01).Conclusion. The revealed changes in the functional connectivity of the default mode network of the brain indicate the functional reorganization of the brain connectome in patients with neurological manifestations of post-mastectomy syndrome.

Ultrasound-guided rhomboid intercostal block for myofascial pain syndrome: a prospective clinical study.

Myofascial pain syndrome (MPS) is a common chronic pain syndrome that may affect quality of life, daily living activities, and psychological status. Ultrasound (US)-guided rhomboid intercostal block (RIB) is a recently defined plane block and used for chronic pain such as postmastectomy syndrome and MPS. Our aim was to evaluate the efficacy of US-guided RIB for the management of pain, quality of life, physical disability, and patient satisfaction in MPS. In this prospective study, between February and March 2021, a total of 30 patients who applied with the diagnosis of MPS, were included. The patients received US-guided RIB. Pain intensity was evaluated using a numerical rating scale (NRS) at pretreatment, and just after the intervention, at day 1, and 1, 2, 4, and 6 weeks after the intervention. At pretreatment and 6 weeks after treatment, Short Form-36 Health Survey (SF-36) for health-related quality of life, Neck Disability Index (NDI), and patient satisfaction were evaluated. There was a statistically significant decrease in average NRS immediately after treatment, at day 1 and week 1,2,4, and 6 compared to the pretreatment (p < 0.0001). The average SF-36 scores advanced at 6 weeks after treatment. There was a statistically significant reduction in mean NDI scores throughout the follow-up period (p < 0.001). Our study demonstrated that RIB had improved neck function, physical and mental quality of life, and patient satisfaction in MPS. Therefore, we think US-guided RIB could be an alternative treatment modality in patients suffering from MPS.

Changes in default mode network connectivity in patients with postmastectomy syndrome

In the modern concept of postmastectomy syndrome (PMES), more attention is paid to the neuropsychiatric component, which observed in more than 90% of patients. Resting state functional magnetic resonance imaging (rs-fMRI) is a promising technique for detecting initial changes of the functional connectivity of brain neural networks in these patients. The aim of the study was to assess changes in the functional connectivity of the default mode network in patients with PMES using resting state functional MRI (rs-fMRI).

Rehabilitation of Cancer Patients аfter Surgical and Combined Treatment for Breast Cancer

Radical surgical treatment, adjuvant chemotherapy and postoperative radiation therapy, used in the complex and combined treatment of breast cancer, inevitably lead to serious functional and psychosomatic disorders. One of the most common complications of breast cancer treatment is postmastectomy syndrome (PMES). That is why the study of the latter and the development of modern methods of rehabilitation of patients with an established diagnosis of PMES remain extremely relevant. To date, the pathogenetic mechanism of the development of upper limb edema and a huge range of possible methods of prevention and treatment have been described in detail. However, the choice of a rehabilitation method requires a personalized approach based on a specific clinical case, and special attention to the psychoemotional status of the patient.