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Immunotherapy has recently been incorporated into the treatment guidelines for metastatic urothelial carcinoma. Nevertheless, the role of prognostic and predictive biomarkers in this setting is not completely defined. To date, PD-L1 expression and a high tumour mutational burden (TMB) seem to predict better responses to immune checkpoint inhibitors, but patients without these biomarkers may still respond to immunotherapy. There are some caveats regarding these biomarkers, such as lack of standardisation of techniques, tumour heterogeneity and other factors influencing the tumour microenvironment. Genomic signatures are other promising emerging strategies. We hereby discuss the management of a 70-year-old man with a metastatic recurrence of urothelial carcinoma within 1 year after neoadjuvant chemotherapy and radical cystectomy. Tumour next-generation sequencing showed a high TMB and a CD274 (PD-L1) amplification. The patient was treated with pembrolizumab and achieved a complete response.
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During initial risk assessments, the metastatic potential of prostate cancer (PCa) may not be fully considered. The tumor's multicentric origin, which is associated with genetic mutations, may explain existing treatment limitations. Investigating human epidermal growth factor receptor 2 (HER2) expression in patients with different stages of PCa may therefore increase understanding of the mechanisms associated with the development of castration resistance. The present study examined the association between HER2 expression and the histologic features of PCa subjected to radical prostatectomy (RP) and evaluated the role of testosterone suppression in HER2 expression. In group 1, specimens from individuals who underwent RP without prior neoadjuvant androgen deprivation therapy (ADT) were included (n=42). In group 2 (PCa with ADT), specimens from individuals who underwent RP and received neoadjuvant cyproterone acetate during distinct periods (200 mg daily for 1-24 months) were included (n=150; cohort derived from a previous study). Immunohistochemical expression of HER2 was associated with prognostic factors such as perineural invasion, extra-prostatic disease, T stage, serum prostate-specific antigen (PSA), angiolymphatic invasion and surgical margins. Univariate regression analysis indicated that perineural invasion, PSA, International Society of Urological Pathology, angiolymphatic invasion, margin, T stage and neoadjuvant ADT was associated with HER2 expression. Ordinal regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (P<0.001). In addition, regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (odd ratio=0.01; 95% CI, 0.00, 0.02; P<0.001). HER2 was expressed in PCa samples but was not associated with known prognostic factors. The use of short-acting ADT and the consequent blockage of testosterone effect may suppress the expression of HER2 in PCa cells.
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The relationship of crops grown in rotation or in succession has increased every day and the use of antagonistic plants and/or non-host plants is one of the most efficient practices of integrated management of nematodes. This study aimed to evaluate the efficiency of crotalaria (Crotalaria spectabilisRoth) and millet [Pennisetum glaucum (L.) Leeke] 'ADR 300' in reducing the population of Meloidogyne incognita and M. javanica and in increasing the productivity of okra [Abelmoschus esculentus (L.) Moench] when cultivated in succession. The experiment was conducted in an area cultivating okra (host culture) in rotation, with a history of severe infestation by phytonematodes. The experimental design involved randomized blocks with six treatments and four replicates, with the following treatments: T1, 15 kg.ha-1 of millet seeds; T2, 30 kg.ha-1 of crotalaria; T3, 10 kg.ha-1 of millet + 20 kg.ha-1 of crotalaria; T4, 20 kg.ha-1 of millet + 6 kg.ha-1 of crotalaria; T5, 6 kg.ha-1 of millet + 36 kg.ha-1 of crotalaria; and T6, control. The nematode populations in the soil and roots were evaluated about 60 d after planting okra, and the yield was evaluated at the end of the crop cycle. Simple treatment with millet or crotalaria reduced the nematode population by 61% and 72%, respectively. The millet-crotalaria intercropping treatments reduced the nematode population by up to 85% compared with the control. In terms of productivity, there was an increase of 787 kg.ha-1 in the millet treatment and 2,109 kg.ha-1 in the intercropping treatments. Both the single cultivation of crotalaria or millet and the consortia of crotalaria and millet were effective in controlling the root-knot nematodes, and increased the productivity of okra.
A relação de culturas cultivadas em rotação ou em sucessão tem aumentado a cada dia, e a utilização de plantas antagônicas e/ou plantas não hospedeiras é uma das práticas mais eficientes de manejo integrado de nematoides. O trabalho teve como objetivo avaliar a eficiência do cultivo de crotalária (Crotalaria spectabilis Roth) e milheto [Pennisetum glaucum (L.) Leeke] 'ADR 300' no incremento de produtividade e redução populacional de Meloidogyne incognita e M. javanica em quiabeiro [Abelmoschus esculentus (L.) Moench] cultivado em sucessão. O experimento foi conduzido em área de rotação com quiabeiro (cultura hospedeira), que tem histórico de grande infestação dos referidos fitonematoides. O delineamento experimental adotado foi o de blocos casualizados com seis tratamentos e quatro repetições, sendo T1 â 15 kg.ha-1 de sementes de milheto, T2 â 30 kg.ha-1 de crotalária, T3 â 10 kg.ha-1 de milheto + 20 kg.ha-1 de crotalária, T4 â 20 kg.ha-1 de milheto + 6 kg.ha-1 de crotalária, T5 â 6 kg.ha-1 de milheto + 36 kg.ha-1 de crotalária e T6 â Testemunha. Foram avaliadas as populações de nematoides no solo e nas raízes cerca de 60 dias após o plantio do quiabeiro e a produtividade ao final do cultivo. Os tratamentos milheto e crotalária solteiros reduziram a população de nematoides em 61 e 72%, respectivamente. Nos cultivos consorciados, obteve-se a redução de 85%, comparado com a testemunha. Quanto a produtividade, houve acréscimo de 787 kg.ha-1 no tratamento com milheto solteiro e de 2.109 kg.ha-1 nos tratamentos consorciados. Tanto o cultivo solteiro de crotalária e milheto, quanto seu uso em consórcio, efetivaram o controle dos nematoides de ganha e elevaram a produtividade do quiabeiro.
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Crotalaria , Abelmoschus , Milhetes , Nematoides , Tumores de Planta , Tylenchoidea , Produtos Agrícolas , Fabaceae , Infecções por NematoidesRESUMO
ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.
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Humanos , Masculino , Idoso , Neoplasias da Próstata/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/patologia , Valores de Referência , Brasil , Modelos Logísticos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Antígeno Prostático Específico/sangue , Estatísticas não Paramétricas , Medição de Risco , Gradação de Tumores , Biópsia Guiada por Imagem/métodos , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. MATERIALS AND METHODS: In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). RESULTS: Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. CONCLUSIONS: Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.
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Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Brasil , Humanos , Biópsia Guiada por Imagem/métodos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Variações Dependentes do Observador , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não ParamétricasRESUMO
Despite low mortality rates, nodal recurrence in papillary thyroid carcinoma occurs in up to 20 % of patients. Emerging evidences indicate that dysregulated microRNAs are implicated in the process of metastasis. In the present study, we investigated whether miR-9, miR-10b, miR-21 and miR-146b levels are predictive of papillary thyroid carcinoma recurrence. Using macro-dissection followed by quantitative real-time PCR, we measured miR-9, miR-10b, miR-21 and miR-146b expression levels in formalin-fixed, paraffin-embedded samples of 66 patients with papillary thyroid carcinoma categorized into two groups: the recurrent group (n = 19) and the non-recurrent group (n = 47). All patients underwent total thyroidectomy and were followed for at least 120 months after surgery to be considered recurrence-free. Univariate and multivariate analysis were performed using the Cox proportional hazard model in order to identify associations between multiple clinical variables and microRNA expression levels and papillary thyroid carcinoma recurrence. MiR-9 and miR-21 expression levels were found to be significant prognostic factors for recurrence in patients with papillary thyroid carcinoma (HR = 1.48; 95 % CI 1.24-1.77, p < 0.001; and HR = 1.52; 95 % CI 1.18-1.94, p = 0.001; respectively). Multivariate analysis involving the expression level of miR-9 and miR-21 and various clinical parameters identified the expression of these microRNAs as independent prognostic factors for papillary thyroid cancer patients. In conclusion, our results support the potential clinical value of miR-9 and miR-21 as prognostic biomarkers for recurrence in papillary thyroid carcinoma.
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Biomarcadores Tumorais/genética , Carcinoma Papilar/secundário , MicroRNAs/genética , Recidiva Local de Neoplasia/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Carcinoma Papilar/genética , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Regulação Neoplásica da Expressão Gênica , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Análise de Sequência com Séries de Oligonucleotídeos , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto JovemRESUMO
Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/- 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.
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OBJECTIVES: To evaluate hyaluronan-mediated motility receptor (RHAMM) expression in normal, hyperplasic and neoplastic prostate tissue after various types and durations of androgen-deprivation therapy (ADT). Clinical and oncological data from men with localised prostate adenocarcinoma were also assessed and compared with RHAMM expression data. PATIENTS AND METHODS: Data from 367 men who underwent histological evaluation of the prostate were retrospectively evaluated under six conditions: (i) benign prostatic hyperplasia (BPH), (ii) BPH treated with finasteride, (iii) prostate cancer without ADT, (iv) prostate cancer treated with neoadjuvant ADT before prostatectomy (cyproterone 200 mg/day), (v) castration-resistant prostate cancer (CRPC), and (vi) normal peritumoral prostate tissue. Tissue microarrays were constructed and 1354 cores were evaluated for immunohistochemical RHAMM expression. RESULTS: There was no RHAMM expression in any tissue from normal patients or those with BPH or prostate cancer without ADT. There was RHAMM expression in 39.4% of prostate cancer tissues treated with ADT and in 46.2% of CRPC samples (P = 0.001). There was a significant increase in RHAMM expression with increased ADT duration in group 4, with a marked increase in RHAMM expression after 6-12 months of ADT (P = 0.04). No prognostic or clinical factors related to prostate cancer were associated with RHAMM expression. CONCLUSIONS: RHAMM expression in prostate cancer is directly associated with ADT. Significant RHAMM expression occurs as early as after 1 month of ADT and progressively increases with ADT duration. When prostate cancer becomes CRPC, RHAMM expression is higher. RHAMM expression was not associated with prostate cancer prognostic factors. RHAMM overexpression may contribute to the development of hormonal resistance in prostate cancer.
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Antagonistas de Androgênios/uso terapêutico , Proteínas da Matriz Extracelular/biossíntese , Receptores de Hialuronatos/biossíntese , Lesões Pré-Cancerosas/metabolismo , Próstata/metabolismo , Hiperplasia Prostática/metabolismo , Neoplasias da Próstata/metabolismo , Idoso , Progressão da Doença , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Prognóstico , Próstata/efeitos dos fármacos , Próstata/patologia , Prostatectomia , Hiperplasia Prostática/patologia , Hiperplasia Prostática/terapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Estudos RetrospectivosRESUMO
Este trabalho tem por objetivo facilitar o diagnóstico da trombose venosa de membros inferiores, diferenciando-a entre superficial e profunda, para que seja instituído o tratamento mais adequado para cada caso.
This article aims to facilitate the diagnosis of lower extremity venous thrombosis, differentiating between superficial and deep, and choose appropriate treatment for each case to be imposed.
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Tromboflebite/diagnóstico , Trombose Venosa/diagnóstico , Serviços Médicos de Emergência , Extremidade InferiorRESUMO
Objective: To evaluate the association between smoking habits and outcome of patients with superficial bladder cancer. Methods: A retrospective study was performed evaluating 99 patients (67.0 ± 13.2 years, ranging from 31.4-93.4 years, 72.7% males and 27.3% females) treated at our institution with non muscle-invasive bladder cancer, between 1994 and 2000, with a mean follow-up of 49.3 months (range 4.0-177.9 months). Patients were divided according to smoking status, and the main measured outcome was progression to invasive disease. Additional cohort analysis was performed dividing patients according to previous tobacco exposure: smokers and non-smokers. Smokers were stratified into former smokers, early-quitters, late quitters and continued smokers. Results: Smoking habit was significantly more common in males (p = 0.03). Cancer also occurred at an earlier age among smokers (70.8 versus 64.8 years, p = 0.030). Tobacco consumption was present in 62.7% of the patients with bladder cancer. There was a significant higher progression rate to muscle-invasive disease in patients that had more than 60 pack-years of exposure (52.9 versus 26.2%, p = 0.037). These patients had a mean progression time of 59.3 months, whereas patients who had smoked less than 60 pack-years progressed after a mean time of 131.8 months. Conclusions: A direct association between the amount of tobacco consumed and disease progression is observed in patients with bladder cancer, as suggested by the present study. Tobacco consumption has a direct association with progression of superficial bladder cancer to invasive disease and also shortens the period of time for muscle invasion. Larger and prospective studies are still necessary to bring further definitive conclusions about reproducibility of our data and to better understand how smoking cessation affects progression of superficial bladder cancer.
Objetivo: Avaliar a relação entre os hábitos tabágicos e a evolução de pacientes com carcinoma urotelial de bexiga superficial. Métodos: Foi realizado um estudo retrospectivo com 99 pacientes (67,0 ± 13,2 anos, variando de 31,4-93,4 anos, 72,7% homens e 27,3% mulheres) tratados de carcinoma urotelial de bexiga não-invasivo entre 1994 e 2000, com seguimento médio de 49,3 meses (4,0-177,9 meses). Os pacientes foram divididos em tabagistas e não-tabagistas, e os tabagistas foram subestratificados entre ex-tabagistas, interruptores precoces, interruptores tardios e tabagistas persistentes. O principal desfecho avaliado foi a progressão para doença invasiva. Resultados: O tabagismo foi mais comum entre os homens (p = 0,03), sendo que 62,6% do total de pacientes avaliados eram tabagistas. O diagnóstico do câncer ocorreu em uma idade mais precoce entre os tabagistas (70,8 versus 64,8 anos, p = 0,03). Observou-se uma progressão significativamente maior para doença invasiva entre os pacientes com carga tabágica acima de 60 maços/ano (52,9 versus 26,2%, p = 0,037). Estes pacientes tiveram um tempo de progressão de 59,3 versus 131,8 meses para aqueles com menor carga tabágica. Conclusões: Há associação direta entre a carga tabágica e progressão do carcinoma urotelial de bexiga para doença músculo-invasiva em um curto intervalo de tempo. Estudos prospectivos e com maior número de pacientes são necessários para entender como a interrupção do tabagismo afeta a progressão do carcinoma superficial de bexiga.
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Carcinoma de Células de Transição , Recidiva Local de Neoplasia , Estudos Retrospectivos , Abandono do Hábito de Fumar , Análise de Sobrevida , Tabagismo , Bexiga UrináriaRESUMO
OBJECTIVE: To evaluate the association between smoking habits and outcome of patients with superficial bladder cancer. METHODS: A retrospective study was performed evaluating 99 patients (67.0 ± 13.2 years, ranging from 31.4-93.4 years, 72.7% males and 27.3% females) treated at our institution with non muscle-invasive bladder cancer, between 1994 and 2000, with a mean follow-up of 49.3 months (range 4.0-177.9 months). Patients were divided according to smoking status, and the main measured outcome was progression to invasive disease. Additional cohort analysis was performed dividing patients according to previous tobacco exposure: smokers and non-smokers. Smokers were stratified into former smokers, early-quitters, late quitters and continued smokers. RESULTS: Smoking habit was significantly more common in males (p = 0.03). Cancer also occurred at an earlier age among smokers (70.8 versus 64.8 years, p = 0.030). Tobacco consumption was present in 62.7% of the patients with bladder cancer. There was a significant higher progression rate to muscle-invasive disease in patients that had more than 60 pack-years of exposure (52.9 versus 26.2%, p = 0.037). These patients had a mean progression time of 59.3 months, whereas patients who had smoked less than 60 pack-years progressed after a mean time of 131.8 months. CONCLUSIONS: A direct association between the amount of tobacco consumed and disease progression is observed in patients with bladder cancer, as suggested by the present study. Tobacco consumption has a direct association with progression of superficial bladder cancer to invasive disease and also shortens the period of time for muscle invasion. Larger and prospective studies are still necessary to bring further definitive conclusions about reproducibility of our data and to better understand how smoking cessation affects progression of superficial bladder cancer.
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UNLABELLED: Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. AIM: to study tissue reaction to cellulose in the dorsal nose of rabbits. MATERIALS AND METHODS: 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. RESULTS: The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. CONCLUSION: The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.
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Cartilagem/transplante , Celulose/biossíntese , Gluconacetobacter xylinus/fisiologia , Doenças Nasais/cirurgia , Nariz/microbiologia , Animais , Materiais Biocompatíveis , Modelos Animais de Doenças , Gluconacetobacter xylinus/química , Gluconacetobacter xylinus/metabolismo , Masculino , Teste de Materiais , Coelhos , Procedimentos de Cirurgia Plástica/métodos , Estatísticas não ParamétricasRESUMO
PURPOSE: Paratesticular sarcomas are rare and frequently reported as isolated case reports. Studies evaluating the relative frequency of the paratesticular sarcomas are limited, and to the best of our knowledge, this is the first study of paratesticular sarcomas in the Brazilian population. PATIENTS AND METHODS: Medical records of all patients undergoing treatment for paratesticular sarcomas between 1993 and 2006 were retrieved from the archives of our institution. RESULTS: Complete data from 12 patients (39 +/- 23 years, range 13-78) with paratesticular sarcomas were available, which represented 6.7% of all orchiectomies performed for testicular malignancies in the same period. At the time of diagnosis, 3 patients had retroperitoneal spread of the disease, all of which had elevated serum lactic dehydrogenase levels. The remaining 9 patients had normal serum markers. There were 6 rhabdomyosarcomas, 4 leiomyosarcomas, 1 liposarcoma and 1 undifferentiated sarcoma. Median follow-up was 31.4 months. Primary surgical excision by inguinal approach was performed in all cases (radical orchiectomy in 10 and preservation of the testis in 2). Retroperitoneal lymph node dissection was performed in 3 patients and excision of the hemiscrotum in 1. Eight patients received adjuvant chemotherapy. Mean overall survival time was 27.8 +/- 6.2 months after orchiectomy. CONCLUSION: Patients with paratesticular sarcomas are at high risk of disease progression, and systemic relapse remains a significant problem, determining poor prognosis. The high risk of local recurrence demands long-term follow-up, and intraoperative frozen section analysis might be of benefit. Elevated lactic dehydrogenase might also be a marker of retroperitoneal disease and poor prognosis. Improvement in survival requires effective systemic adjuvant therapy.
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Neoplasias dos Genitais Masculinos , Sarcoma , Escroto , Adolescente , Adulto , Idoso , Brasil , Neoplasias dos Genitais Masculinos/epidemiologia , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma/epidemiologia , Sarcoma/patologia , Sarcoma/terapia , Testículo , Adulto JovemRESUMO
Vários materiais são propostos para reconstrução nasal, não havendo consenso sobre qual o melhor. A manta de celulose produzida por bactéria pode ser mais um elemento para adição cartilaginosa. Não há estudos deste material no dorso nasal. OBJETIVO: Avaliar a resposta tecidual à presença da celulose bacteriana no dorso nasal de coelhos. MATERIAL E MÉTODO: Foram utilizados 22 coelhos Nova Zelândia, sendo que em 20 deles foi implantada a manta de celulose no dorso nasal e em 2 controles nada foi feito. Foram acompanhados por um período de três e seis meses, sendo então retirados as regiões do dorso nasal e narinas dos coelhos e realizado estudo histopatológico levando em consideração parâmetros definidos de condição inflamatória como congestão vascular, intensidade do processo inflamatório e presença de exsudato purulento. RESULTADOS: O processo inflamatório manteve-se estável, demonstrando sua relação com o procedimento cirúrgico, e não com a presença da manta de celulose. Nos demais parâmetros estudados não houve diferença estatisticamente significante. CONCLUSÃO: A manta de celulose de Acetobacter xylinum mostrou boa biocompatibilidade e manteve-se estável no decorrer do tempo de estudo, podendo ser considerada um bom material para uso na elevação do dorso nasal.
Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. AIM: to study tissue reaction to cellulose in the dorsal nose of rabbits. MATERIALS AND METHODS: 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. RESULTS: The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. CONCLUSION: The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.
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Animais , Masculino , Coelhos , Cartilagem/transplante , Celulose/biossíntese , Gluconacetobacter xylinus/fisiologia , Doenças Nasais/cirurgia , Nariz/microbiologia , Materiais Biocompatíveis , Modelos Animais de Doenças , Gluconacetobacter xylinus/química , Gluconacetobacter xylinus/metabolismo , Teste de Materiais , Procedimentos de Cirurgia Plástica/métodos , Estatísticas não ParamétricasRESUMO
PURPOSE: Prostate cancer is the most frequently diagnosed neoplasm in men. In some patients, however, the disease pursues a clearly more aggressive course. Testicular metastases from prostate cancer are rare events that have been previously reported; however, its frequency and clinical meaning are not well established. The aim of the present study was, therefore, to evaluate its occurrence and clinical meaning. PATIENTS AND METHODS: A review of patients who underwent androgen deprivation orchidectomy for prostate cancer between 1995 and 2007 was undertaken. On the period evaluated, 1,693 orchidectomies were performed at our institution. Since, the population of patients treated at our institution does not have access to the expensive androgen-deprivation drugs, the vast majority is treated through surgical castration. In such context, evaluation of testicular parenchyma of patients with advanced prostate cancer could be assessed. Clinical and histological data were reviewed, and patients with testicular metastases were identified. RESULTS: Of the 1,693 orchidectomies performed during the period analysed, three cases of testicular metastases of prostate cancer (range 58-76 years) were diagnosed (0.18%). All patients had very atypical neoplasm's behaviour and poor prognosis, dying within the first year. CONCLUSION: In conclusion, testicular metastases from prostate cancer are a rare event, observed in 1.8 per 1,000 cases. As other visceral metastases, testicular metastases might also be considered as an unusual additional factor of poor prognosis.
Assuntos
Neoplasias da Próstata/patologia , Neoplasias Testiculares/secundário , Idoso , Progressão da Doença , Humanos , Masculino , Pessoa de Meia-Idade , Orquiectomia , Prognóstico , Neoplasias da Próstata/cirurgia , Neoplasias Testiculares/cirurgiaRESUMO
Objective: The aim of the study was to assess the frequency of high-grade prostate intraepithelial neoplasia and atypical small acinar proliferations on a contemporary series, and their relation to posterior diagnosis of prostate cancer. Methods: A retrospective study was conducted with 6,490 consecutive men submitted to extended prostate biopsies between 2000 and 2005 at a single institution. Of these, 400 men (6.16%) had atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia, and 43 had at least one follow-up biopsy. Results: The overall incidence of high-grade prostatic intraepithelial neoplasia was 4.6% and 1.4% for atypical small acinar proliferation. High-grade prostatic intraepithelial neoplasia plus atypical small acinar proliferation occurred in 0.11% of men. The detection rates of prostate cancer on repeated biopsies were of 38.5 and 53.6% for high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation, respectively. All patients with high- grade prostatic intraepithelial neoplasia plus atypical small acinar proliferation who had a repeated biopsy were diagnosed with prostate cancer. There was a higher risk of diagnosing prostate cancer in a site close to previous atypical small acinar proliferation (OR = 5.93; p = 0.015). Conclusions: After high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation finding on extended biopsies, close follow-up is recommended, and repeated biopsies should be done according to clinical data as well. Rebiopsies should be strongly recommended when the association high- grade prostatic intraepithelial neoplasia plus atypical small acinar proliferation is present, or when atypical small acinar proliferation is found only after the second biopsy. Repeated biopsies after an atypical small acinar proliferation finding should be always randomized, but sites of atypical small acinar proliferation should be more extensively sampled.
Objetivo: O objetivo do estudo foi avaliar a frequência de neoplasia intraepitelial prostática de alto grau e de proliferações atípicas de pequenos ácinos em uma série atual, e sua relação com o diagnóstico de câncer de próstata. Métodos: Foi realizado estudo retrospectivo com 6.490 homens submetidos consecutivamente a biópsia estendida de próstata entre 2000 e 2005. Destes, 400 (6,16%) apresentaram proliferações atípicas de pequenos ácinos ou neoplasia intraepitelial prostática de alto grau, e 43 foram submetidos à rebiópsias. Resultados: A incidência de neoplasia intraepitelial prostática de alto grau foi de 4,6% e, de proliferações atípicas de pequenos ácinos, 1,4%. Neoplasia intraepitelial prostática de alto grau mais proliferações atípicas de pequenos ácinos ocorreu em 0,11% dos homens. Detecção de câncer de próstata em rebiópsias ocorreu em 38,5 e 53,6% dos homens com neoplasia intraepitelial prostática de alto grau e proliferações atípicas de pequenos ácinos, respectivamente. Todos os homens com neoplasia intraepitelial prostática de alto grau mais proliferações atípicas de pequenos ácinos apresentaram câncer de próstata em rebiópsias. Observou-se um risco elevado de detecção de câncer de próstata próximo ao local onde ocorreram proliferações atípicas de pequenos ácinos previamente (OR = 5,93; p = 0,015). Conclusões: Após o achado de neoplasia intraepitelial prostática de alto grau ou proliferações atípicas de pequenos ácinos em biópsias estendidas, seguimento cauteloso é recomendado, e rebiópsias devem ser realizadas de acordo com dados clínicos. Rebiópsias são fortemente recomendadas quando há associação da neoplasia intraepitelial prostática de alto grau mais proliferações atípicas de pequenos ácinos, ou quando proliferações atípicas de pequenos ácinos são encontradas a partir da segunda biópsia repetida. Rebiópsias após proliferações atípicas de pequenos ácinos devem ser randomizadas, porém locais onde ocorreu o achado de proliferações atípicas de pequenos ácinos devem ser mais extensivamente representados.
RESUMO
Objective: to evaluate patients treated with primary bladder adenocarcinoma at our institution. Methods: A review of 30 patients diagnosed with bladder adenocarcinoma at a single institution from 1994 of 2005 was undertaken. Cases of primary bladder adenocarcinoma were retrospectively evaluated. Results: Out of 490 patients with bladder carcinoma, 30 had bladder adenocarcinoma: 22 metastatic tumors, eight (1.6%) primary adenocarcinoma. Of these, three (0.6%) were primary non-urachal and five (1.0%) were urachal adenocarcinoma. All patients were men with mean age of 55.8 years (range 37-83). Dysuria and hematuria were the main symptoms reported. Of the total, four patients had cancer-related mortality. Conclusion: Primary bladder adenocarcinoma is a rare neoplasm, observed in 1.6% patients with bladder malignancies. Late diagnosis limits therapeutic possibilities. Partial cystectomy seems to have unsatisfactory results and radical cystectomy, although remains as the gold standard, have no proven efficacy. New methods of adjuvant treatment must be studied to improve treatment outcomes, as high mortality is observed despite treatment.
Objetivo: avaliar pacientes com adenocarcinoma primário da bexiga tratados em uma instituição. Métodos: foi realizada uma revisão em 30 pacientes diagnosticados com adenocarcinoma da bexiga, em uma única instituição, no período de 1994 a 2005. Os casos de adenocarcinoma primário da bexiga foram avaliados retrospectivamente. Resultados: dos 490 pacientes tratados com carcinoma da bexiga, 30 tinham adenocarcinoma da bexiga: 22 eram tumores metastáticos, oito (1,6%) tinham adenocarcinoma primário. Destes, três (0,6%) eram não-úraco primários e cinco (1,0%) do úraco. Todos os pacientes eram homens com média de idade de 55,8 anos (entre 37-83). Disúria e hematúria foram os sintomas predominantes. Do total, quatro pacientes tiveram mortalidade relacionada ao câncer. Conclusões: adenocarcinoma da bexiga é um tumor raro, observado em 1,6% dos pacientes com neoplasias da bexiga. O diagnóstico tardio limita as possibilidades terapêuticas. A cistectomia parcial parece ter resultados pouco satisfatórios e a cistectomia radical, embora permaneça o padrão ouro, não provou eficácia. Novos métodos de tratamentos adjuvantes devem ser estudados para melhorar os resultados terapêuticos, pois alta mortalidade é observada mesmo após o tratamento.
RESUMO
UNLABELLED: Exuberant scarring tissue formation is among the failure causes of tracheal stenosis surgery. Dressings that could avoid such reaction could be very helpful in these cases. Bacterial cellulose, produced by acetobacter xylinun can be useful in these cases. There are no studies in the laryngotracheal region. AIM: To assess subglottic tissue response in rabbits after scarification and placement of cellulose dressing, and comparing it to a control group. STUDY DESIGN: Experimental. MATERIALS AND METHODS: 26 rabbits underwent laryngotracheal scarification, received the dressing and were compared to the control group. We established four follow up periods. Laryngotracheal specimens underwent histological exam and the results were statistically assessed. RESULTS: The study group had statistically similar results when compared to the control group in the following parameters: vascular congestion, purulent oozing, acute inflammation, epithelial integrity, fibrous proliferation and granulous proliferation. CONCLUSION: We did not observe differences between the study and control groups as far as inflammation and scarring are concerned. There were no inflammatory signs associated with the use of the cellulose membrane that did no occur because of surgery.
Assuntos
Curativos Biológicos , Celulose/uso terapêutico , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/prevenção & controle , Traqueíte/patologia , Cicatrização/efeitos dos fármacos , Animais , Feminino , Gluconacetobacter xylinus , Masculino , Coelhos , Distribuição Aleatória , Estenose Traqueal/patologiaRESUMO
Dentre as causas de insucesso nas cirurgias para a estenose traqueal está a formação de tecidos de cicatrização exuberantes. O uso de curativos para evitar esta reação pode ser de grande valia nestes casos. A celulose bacteriana produzida por acetobacter xylinun pode ser útil nestes casos. Não há estudos na região laringotraqueal. OBJETIVO: Avaliar a resposta tecidual subglótica de coelhos após escarificação e colocação de curativo de celulose, comparando com grupo controle. FORMA DE ESTUDO: Experimental MATERIAL E MÉTODOS: Foram estudados 26 coelhos, submetidos a escarificação da região laringotraqueal e tratados com curativo e comparados com controle. Foram estabelecidos 4 tempos de seguimento. Os seguimentos laringotraqueais foram examinados histologicamente e os resultados foram avaliados estaticamente. RESULTADOS: O grupo de estudo evoluiu com o passar do tempo com resultados estatisticamente semelhantes ao do grupo controle, nos parâmetros Congestão vascular, Exsudato purulento, Inflamação aguda, Integridade do epitélio, Proliferação fibrosa e Reação granulomatosa. CONCLUSÃO: Não foram observadas diferenças entre os grupos controle e de estudo quanto aos parâmetros inflamatórios ou cicatriciais. Não houve sinais inflamatórios relacionados ao uso da membrana de celulose que não tivessem ocorrido devido ao traumatismo cirúrgico.
Exuberant scarring tissue formation is among the failure causes of tracheal stenosis surgery. Dressings that could avoid such reaction could be very helpful in these cases. Bacterial cellulose, produced by acetobacter xylinun can be useful in these cases. There are no studies in the laryngotracheal region. AIM: to assess subglottic tissue response in rabbits after scarification and placement of cellulose dressing, and comparing it to a control group. STUDY DESIGN: experimental. MATERIALS AND METHODS: 26 rabbits underwent laryngotracheal scarification, received the dressing and were compared to the control group. We established four follow up periods. Laryngotracheal specimens underwent histological exam and the results were statistically assessed. RESULTS: the study group had statistically similar results when compared to the control group in the following parameters: vascular congestion, purulent oozing, acute inflammation, epithelial integrity, fibrous proliferation and granulous proliferation. CONCLUSION: we did not observe differences between the study and control groups as far as inflammation and scarring are concerned. There were no inflammatory signs associated with the use of the cellulose membrane that did no occur because of surgery.
Assuntos
Animais , Feminino , Masculino , Coelhos , Curativos Biológicos , Celulose/uso terapêutico , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/prevenção & controle , Traqueíte/patologia , Cicatrização/efeitos dos fármacos , Gluconacetobacter xylinus , Distribuição Aleatória , Estenose Traqueal/patologiaRESUMO
OBJECTIVES: Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammation of the renal parenchyma that occurs in the presence of chronic obstruction and suppuration. In this retrospective study, a review of the features of 41 recent cases of XGP is presented and compared with current published data. METHODS: We retrospectively evaluated the clinical, surgical, and radiologic features of 41 cases of XGP and compared the data of this Brazilian population with that from current published reports. RESULTS: XGP was diagnosed in 19.2% of all nephrectomies performed for pyelonephritis during the period analyzed. Of the 41 patients with XGP, 85.4% were women and 14.6% were men. All patients were symptomatic, and the most common symptoms were fever, flank or abdominal pain, weight loss, lower urinary tract symptoms, and gross hematuria. The most frequent computed tomography findings included hydronephrosis, kidney enlargement, poor excretion of contrast medium, and air in the urinary tract. All patients had renal calculi, 34.1% of which were staghorn calculi. All patients underwent nephrectomy. For the few cases in which laparoscopy was performed, the conversion rate was high. CONCLUSIONS: XGP is a common histologic variant of surgically managed pyelonephritis, corresponding to almost 20% of such cases. As described in other series, we found a population that largely consisted of middle-age women. The clinical presentation was characterized mainly by pain and constitutional symptoms. The main etiologic agent isolated was Escherichia coli, and in all cases, calculi were present. Computed tomography can be considered the best imaging study to diagnose XGP, and in the few cases managed by laparoscopy, high conversion rates were observed.