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En Uruguay el cáncer de mama ocupa el primer lugar en incidencia y mortalidad por cáncer en la mujer. El conocimiento de la distribución de los factores de riesgo relacionados con el desarrollo de la enfermedad facilita la incorporación de estrategias de prevención en la práctica clínica habitual, lo que podría contribuir a disminuir los índices de morbimortalidad. Objetivos: conocer el perfil epidemiológico para el cáncer de mama y la frecuencia del control mamográfico en la población encuestada.- Material y Métodos: Se aplicó una encuesta a mujeres uruguayas. Luego de realizada la misma, se les brindó información sobre los factores de riesgo y protectores y sobre la importancia de realizar el control mamográfico. Resultados: Se incluyeron 296 encuestadas, la mediana de edad fue 36 años (18-80 años). Excluyendo el sexo femenino (factor de riesgo presente en todas las encuestadas), 133 encuestadas (44,9 %) presentaban uno o más factores de riego. La mayoría de las mujeres mayores de 50 años (117, 90%), realizaban control mamográfico al menos en forma bianual. Conclusiónes: Concordantemente con lo reportado por el Programa Nacional de Cáncer de Mama, 44,9% de las encuestadas tuvieron algún factor de riesgo. La mayoría de las encuestadas mayores de 50 años realizaban control mamográfico y clínico al menos en forma bianual. Si bien, debido a las características del trabajo, solamente podemos sacar conclusiones sobre las mujeres incluidas, los datos recogidos nos permiten conocer mejor el perfil epidemiológico de la población uruguaya, lo que puede contribuir a las prácticas de prevención.

Male breast cancer (MBC) is a rare condition which, while sharing some similarities with breast cancer in women, has a unique disease profile of its own. Aim: To understand the characteristics of MBC and its management in Uruguay. Patients & methods: Retrospective observational study that included patients diagnosed with MBC. Results: 22 cases of MBC were found. The median age at diagnosis was 62.5 years. Symptoms included self-detected lump in 17 patients (77.3%) and nipple retraction in seven (22.7%). Ductal carcinomas of histological grade 2–3 were found in 20 patients (90.9%) and stage I–II disease was most commonly encountered (15 patients, 68.1%). Neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy and tamoxifen were offered to 16 (73%), 12 (54.5%), 17 (65.4%) and 20 (90.9%) patients, respectively. Conclusion: MBC behaves and is treated in many aspects like postmenopausal breast cancer. Further multi-institutional, prospective studies are needed for better understanding and management of male breast cancers.

Aim To report the results of a two-stage reconstruction of septic non-unions of the upper limb using the bone-and-strut technique with a follow-up of more than two years. Methods A total of 19 patients (12 males and seven females; age 27 to 85 years) were included in this cohort study. The evaluation endpoint was set at 24 months. Radiographic union, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, pain and return to work were assessed. All patients were treated with debridement and antibiotic therapy. At a second stage, the nonunion focus was filled with a cancellous bone allograft. Stability was provided using a locking plate and a bone strut. Results After 24 months, the QuickDASH scores improved from a median of 28 (interquartile range, 13 - 35 points), to a median of 78 (interquartile range, 70 - 89 points). Mean pain scores improved from 8.1 (range, 0.3-10) to 0.6 (range 0-2). Radiographic and clinical union was seen in all patients. The majority of patients returned to work or previous activities when retired. A new neurological deficit, recurrence of infection, or other surgery-related adverse events were not observed. Conclusion The two-stage bone-and-strut technique is a safe and effective technique in the treatment of septic non-unions of the upper limb. The union rate is high, the complication rate is acceptable and return return-to-work is high. Recurrence of infectious sequelae during a follow-up period of at least two years was not seen. The patient-reported outcomes increased significantly.

Natalia Camejo Martínez: Asistente del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Cecilia Castillo: Prof. Adj. del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Nora Artagaveytia: Prof. Adj. del Departamento Básico de Medicina, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Ana Laura Hernández: Prof. Adj. del Departamento de Psicología Medica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Andrea Schiavone: Asistente del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Soledad Milans: Prof. Adj. con Orientación en Imagenología Mamaria del Departamento de Imagenología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Guillermo Laviña: Ex Prof. Adj. Clínica Quirúrgica 1, Facultad de Medicina, Universidad de la República, Uruguay.-- Lucía Delgado: Prof. Directora del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Contacto: ncam3@yahoo.com El cáncer de mama ocupa el primer lugar en incidencia y mortalidad en el Uruguay. El conocimiento de la distribución de los factores de riesgo relacionados con el desarrollo de la enfermedad facilita la incorporación de estrategias de prevención en la práctica clínica habitual, lo que podría contribuir a disminuir los índices de morbimortalidad. Objetivos: conocer el perfil epidemiológico para el cáncer de mama y la frecuencia del control mamográfico en la población encuestada. Material y Métodos: Se aplicó una encuesta a mujeres uruguayas, luego de realizada, se les brindó información sobre los factores de riesgo y protectores y sobre la importancia de realizar el control mamográfico. Resultados: Se incluyeron 182 encuestadas, la mediana de edad fue 34 años (18-75 años). Excluyendo el sexo femenino (factor de riesgo presente en todas las encuestadas), 73 encuestadas (48%) presentaban uno o más factores de riego. La mayoría de las mujeres mayores de 50 años (58; 87,8%), realizaban control mamográfico al menos en forma bianual. Conclusiones: Concordantemente con lo reportado por el Programa Nacional de Cáncer de Mama, 40% de las encuestadas tuvieron algún factor de riesgo. La mayoría de las encuestadas mayores de 50 años realizaban control mamográfico y clínico al menos en forma bianual. Si bien, debido a las características del trabajo, solamente podemos obtener conclusiones sobre las mujeres incluidas, los datos recogidos nos permiten conocer mejor el perfil epidemiológico de la población uruguaya, lo que puede contribuir a las prácticas de prevención. Breast cancer ranks fi rst in incidence and mortality in Uruguay. The knowledge of the distribution of risk factors related to the development of the disease facilitates the incorporation of prevention strategies in routine clinical practice, which could contribute to lower morbidity and mortality rates. Objectives: to know the epidemiological profi le for breast cancer and the frequency of mam mographic control in the surveyed population. Material and Methods: A survey was applied to Uruguayan women. After the same, they were given information about the risk and protective factors and the importance of performing mammographic control. Results: 182 respondents were included; the median age was 34 years (18-75 years). Excluding the female sex (risk factor present in all respondents), 73 respondents (48%) had one or more risk factors. The majority of women older than 50 years (58; 87.8%), performed mammographic control at least biannually. Conclusions: Consistent with what was reported by the National Breast Cancer Program, 40% of the respondents had some risk factor. The majority of respondents over 50 years of age performed mammographic and clinical control at least bi-annually. Although, due to the characteristics of the work, we can only draw conclusions about the women included, the data collected allow us to better understand the epidemiological profi le of the Uruguayan population, which can contribute to prevention practices. O câncer de mama ocupa o primeiro lugar em incidência e mortalidade no Uruguai. O conhecimento da distribuição dos fatores de risco relacionados ao desenvolvimento da doença facilita a incorporação de estratégias de prevenção na prática clínica de rotina, o que poderia contribuir para menores taxas de morbidade e mortalidade. Objetivos: Conhecer o perfi l epidemiológico do câncer de mama e frequência de controle da população mamográfi ca encuestada. Material e Métodos: A pesquisa foi aplicada mulheres uruguaias. Após o mesmo, foram dadas in formações sobre os fatores de risco e proteção e a importância da realização do controle mamográfico. Resultados: 182 respondentes foram incluídos, a mediana de idade foi de 34 anos (18-75 anos). Excluindo o sexo feminino (fator de risco presente em todos os entrevistados), 73 entrevistados (48%) apresentavam um ou mais fatores de risco. A maioria das mulheres com idade superior a 50 anos (58; 87,8%) realizaram o controle mamográfico pelo menos semestralmente. Conclusões: Consistente com o que foi relatado pelo National Breast Cancer Program, 40% dos respondentes tinham algum fator de risco. A maioria dos entrevistados com mais de 50 anos de idade realizou controle mamográfi co e clínico pelo menos bianualmente. Embora, devido às características do trabalho, só podemos tirar conclusões sobre mulheres incluídas, os dados coletados nos permitem compreender melhor o perfi l epidemiológico da população uruguaia, que pode contribuir para práticas de prevenção.

Background:There is a high incidence of blood transfusion following hip fractures in elderly patients.Aim:The aim of this study is to evaluate the effectiveness and complications of use of tranexamic acid in proximal femur nailing surgery.Materials and methods:Our sample group consisted of 90 patients suffering from pertrochanteric fractures surgically treated with osteosynthesis with SupernailGT(LimaCorporate). The classification system AO/OTA was used to divide the fractures into 31A1 (n=45) and 31A2 (n=45). The patients were divided into two groups: 47 patients were administered 15 mg of tranexamic acid per kg (group A) and 43 patients were administered placebo (group B). Blood counts were monitored daily to evaluate the rate of anemia. As a safety criterion, we monitored the possible occurrence of vascular events, symptomatic or not, over the 8 weeks post-surgery. Markers predicting mortality and deep venous thrombosis (DVE) were also monitored (fibrinogen D-dimer).Results:Blood loss occurring post-surgery can be influenced by numerous factors that are not linked to the use or non-use of tranexamic acid. While closely monitoring hemoglobin levels daily, we observed that 42% of the patients in group A required blood transfusion as opposed to 60% in group B. The results of the markers predicting mortality (alpha1-acid glycoprotein; albumin LDL) and those of DVE were not statistically significant between the two groups in this study (p>0.05).Conclusion:Based on this study, the use of tranexamic acid was statistically significant in reducing post-surgery blood loss.

Aim The gradual increase in shoulder implants in active elderly patients has appeared in a parallel increase in periprosthetic humeral fractures. The aim of this study was to investigate the advantages of using strut grafting with plate fixation during periprosthetic humerus fractures. Methods Thirty patients diagnosed with periprosthetic humeral fracture were divided into two groups. The first group of 15 patients (PS) underwent plate, ring, screws and strut allografts. The second group with resting 15 patients (PWS) was treated with only plate and screws. The criteria to evaluate the groups during followup were the Constant Shoulder Score (CSS) and Oxford Shoulder Score (OSS); the bone healing was measured by X-rays, controls measured by radiographic union score (RUS), and complications. The follow up was terminated at 12nd month in both groups. Results The difference between the two groups in all parameters was not significant. However, all patients gained adequate shoulder motor skills for normal daily living activities. All fractures were healed. Only two complications were registered, and blood loss was minimal. Conclusion We believe a revision to reverse shoulder prosthesis with a long-stem implant with or without cortical strut allograft augmentation to be safe and appropriate in the management of these complex injuries, though technically challenging, and having good results for normal activities daily life.

e12028 Background: BRCA1 is one of the main susceptibility genes for breast cancer (BC). While BRCA1 mutations are rare in sporadic tumors, loss or reduction of gene expression have been reported in approximately 30-50% of sporadic BCs in the general population. From the molecular point of view, there is no clear characterization of these tumors in young women and we have found no studies reporting the rate of under-expression of BRCA1 in women with sporadic BC under 40 years of age. Objective: to assess the tumor expression of BRCA1 using immunohistochemistry (IHC) and its prognostic value in Uruguayan women diagnosed with BC before the age of 40 years. Methods: IHQ was used to analyze the tumor expression of BRCA1 in paraffin-embedded tumor samples of 40 BC patients diagnosed before the age of 40 between 01/01/2006 and 12/31/2012. The optimization and determination of the BRCA1 protein by IHC was centralized. The antibodies used were anti BRCA1 MS110 monoclonal antibodies against the N-terminal end and GLK-2 against the C-terminal end (amino acids 1839-1863). Expression was considered positive when >10% of the cells had nuclear and/or cytoplasmic labeling. Overall survival (OS) and disease free survival (DFS) were calculated; the curves were developed using the Kaplan-Meier method and the difference in survival was evaluated through the log rank test. Results: the average age of the 40 patients included was 36 years; 8 patients (20%) had significant family history of BC or ovarian cancer. The distribution by stage (S) was as follows: SI: 9 patients (22.5%); SII: 20 patients (50%); SIII: 10 patients (25%), and SIV: 1 patient. Regarding the biological profile: 17 patients (42.5%) were HER2- and ER/PR+, 13 (32.5%) were HER2+ and the remaining 10 patients (25%) were classified as triple negative. The 5-year OS and DFS were 73% and 60% respectively. The expression of BRCA1 with GLK-2 was ≤10% in 16 of the 40 patients included (40%). The 5-year OS and DFS for patients with ≤10% expression was 56% vs. 85% for patients with >10% (p = 0.015) and 40% vs. 72% (p = 0.034) respectively. The expression of BRCA1 by MS110 was ≤10% in 11 of the 40 patients included (27.5%). No statistically significant differences were found in the 5-year OS or DFS based on the expression of this marker. Conclusions: Decreased BRCA1 tumor expression as assessed by IHC using GLK-2 was found in 40% of young patients included and was associated with unfavorable prognosis.

e13554Background: CC is a significant public health problem in Uruguay because despite having a comprehensive national prevention plan, the disease continues to impact the most vulnerable women in ...

e21663 Background: To assess the impact of incorporating systematic quality of life measurements in oncology practice on the quality of care and well-being of patients; to assess physician's level of satisfaction with this instrument and detectable changes in clinical practice Methods: In a prospective study, 67 patients (pts) diagnosed with cancer, undergoing cancer-specific treatments, were randomized into a intervention and control group. In the intervention group , pts had regular completion of touch-screen health-related quality of life (HRQL) questionnaires (European Organization for Research and Treatment of Cancer–Core Quality of Life Questionnaire version 3.0, and Hospital Anxiety and Depression Scale) and feedback of results to physician and then were followed up with a phone call where HRQL was measured by the Functional Assessment of Cancer Therapy–General questionnaire (FACT-G). In the control group, pts were regular followed with a phone call to answer FACT-G questionnaire. Physicians completed a visit-specific questionnaire after each visit of pts from intervention group. Results: 58 pts were included, 36 in the intervention group and 22 in the control group. Median age was 59 years. The results of the patient-reported data were found to be very useful to quite useful by 87.5% of physicians (14/16), and 56.3% of them considered that there was no difference in the length of visits. Completing the HRQL questionnaires on a touch screen was easy to very easy for 97.1% of patients, and 97.1% found that important questions were asked and that they would be willing to complete the questionnaires. FACT-G scores and subscale scores were higher in the intervention group, but differences were not statistically significant (76.44 v 72.60; p 0.388). Conclusions: HRQL assessments had a positive impact on physician-patient communication. It made it possible to learn how cancer and its treatments affected pts not only physically, but also on functional and psychological states and social relationships. They helped us improve therapeutic interventions and specialist referrals, thus achieving positive changes in the well-being and satisfaction of pts.

Background: The aim of this study was to evaluate how the ultrasound examination in the carpal tunnel diagnosis could contribute to the clinical and neurophysiological evaluation. This was done by evaluating the cross-sectional area (CSA) and its correlation with symptoms and functionality data assessed by the BTQC questionnaire. Methods: 60 patients were subjected to open CTR for idiopathic carpal tunnel syndrome. The median nerve CSA was assessed both pre-operatively and in follow-up at 4 and 12 weeks. The Boston Carpal Tunnel Questionanaire (BCTQ) was proposed at the same time. Results: BCTQ score significantly improved after 4 weeks, but there was a less significant increase at 12 weeks for both the BCTQ-S and the BCTQ-F. The 4-week CSA, however, did not appear to have markedly improvement, where as the 12-week CSA turned out to be statistically significant. The correlation between BCTQ and CSA shows that post-surgery, the reduction of CSA of the median nerve is correlated with the symptomatic and functional reduction in patients. Conclusions: The study shows that the symptomatology and the functionality of the hand after surgery for the carpal tunnel resolves quickly. Furthermore, the reduction of the CSA proves to show that the use of ultrasound can help in the evaluation of patients with this state.

143 Background: To evaluate the incidence, severity and outcome of Trastuzumab-induced cardiotoxicity in HER2 positive Uruguayan breast cancer (BC) patients. Methods: Retrospective observational analysis of HER2 positive BC patients who were treated with Trastuzumab (TTZ) from January 2007 to December 2013 at two Uruguayan centers. Cardiac monitoring included physical examination and assessment of left ventricular ejection fraction (LVEF) by echocardiography that was evaluated before TTZ administration and every 12 weeks thereafter during the duration of therapy. Cardiovascular risk factors analyzed were: obesity (BMI ≥ 30 kg/m2), hypertension, diabetes, sedentary lifestyle and high cholesterol. Results: Sixty nine female patients were found in the databases of our institutions. Median age was 48 years (range: 27-73). Stage at diagnosis was as detailed: 19 % EI, 46 % EII, 29 % EIII and 4 % EIV. Eighty nine percent of patients received adjuvant TTZ , 4 % neoadjuvant TTZ and 7 % received it as a palliative therapy. Thirty patients (43, 5%) had at least one cardiovascular risk factors: 26% hypertension, 16% obesity, 9% sedentary lifestyle, and 4% high cholesterol. Median number of TTZ cycles was 15. Cycles were administered every 3 weeks at standard dose. Nineteen patients (27%) developed cardiotoxicity, of whom 12 had a transient suspension because of a reversible fall in LVEF, 2 had a irreversible reduction in LVEF, and 5 had a symptomatic heart failure. Eighty-nine percent of our patients (62 patients) completed treatment and the rest had a definitive suspension due to a irreversible reduction in LVEF or symptomatic heart failure. Most patients that developed cardiotoxicity (15 out of 19) had cardiovascular risk factors and also most of them (16 out of 19) had received anthracyclines before TTZ. Conclusions: Cardiotoxicity incidence was similar to the incidence reported in the literature and when it was present, in most cases was transient, asymptomatic, and reversible.

e11547 Background: To investigate the frequency, clinical pathological characteristics and prognosis of young women with breast cancer (BC) less than 40 years old and estimate disease free survival...