ABSTRACT
Objectives: The objective of this study is to compare the joint range of motion (ROM) reduction between the submitted limb to lymphadenectomy and contralateral and to evaluate if ROM restriction is also connected with lymphedema. Materials and Methods: Evaluated were 84 patients submitted to axillary lymphadenectomy (n=40), inguinal (21) or ilioinguinal (23) for the treatment of cutaneous melanoma, operated between 1990 and 2008. Individuals excluded were those with amputation of a limb or bilateral dissection that would make perimetry and goniometry comparison impossible. The invited patients were submitted to goniometric evaluation of the shoulder or hip and measurement of the upper or lower limbs through manual perimetry. Results: The difference of 4.2 degrees between the averages of ROM flexion (p=0.005) of the shoulder of the affected side in relation to the control, and 5.2 degrees in abduction (p=0.002) were sufficient to be statistically significant, with the exception of 3 degrees of external rotation (p=0.135). The differences between the means of hip ROM were also significant, varying 8.5 degrees in flexion (p <0.001) and 2.2 degrees in abduction (p=0.011). The ROM of the shoulder or hip of the affected side did not present differences between the 33 patients with lymphedema in relation to the 51 patients without lymphedema: shoulder with flexion (p=0.148), abduction (p=0.577) and external rotation (p=0.866); hip with flexion (p = 0.665) and abduction (p=0.795). Conclusion: In spite of individuals with lymphadenectomy show restriction of joint ROM in flexion and abduction of the shoulder and hip in the late postoperative period, there was no association between joint ROM, of the shoulder on both the hip and the presence of lymphedema.
Subject(s)
Humans , Arthrometry, Articular , Lymph Node Excision , Lymphedema , Melanoma , Postoperative Period , Shoulder JointABSTRACT
INTRODUÇÃO: O carcinoma epidermóide de esôfago (CEE) possui alta incidência em nosso país, com altas taxas de mortalidade. A família dos receptores do fator epitelial de crescimento (EGFR) é composta por quatro membros, e muitos estudos têm sido direcionados para a expressão de EGFR e c-erbB-2, com implicações terapêuticas. OBJETIVO: Investigar as expressões imuno-histoquímicas de EGFR e c-erbB-2 e correlacioná-las a aspectos clinicopatológicos em casos de CEE. MATERIAL E MÉTODOS: Para esse estudo, dados clinicopatológicos de 613 CEE foram revistos. A imunoistoquímica foi feita utilizando anticorpo policlonal para c-erbB-2 e monoclonal para EGFR em 597 e 585 casos, respectivamente. Os casos representados por peças cirúrgicas foram distribuídos em três blocos de parafina de tissue microarray (TMA), inseridos em duplicata; aqueles com biópsias foram analisados em corte convencional. Todos foram classificados de acordo com intensidade e padrão de marcação de membrana das células tumorais. RESULTADOS: As expressões de c-erbB-2 e EGFR foram observadas em 42,4 por cento e 77,6 por cento dos casos, respectivamente. Observou-se correlação estatisticamente significativa entre as expressões de c-erbB-2 (p = 0,04) e EGFR (p = 0,01) e grau histológico. Ambos os marcadores foram significativamente mais expressos em casos bem/moderadamente diferenciados do que nos pouco diferenciados/indiferenciados. Embora não tenha sido significativa, houve uma tendência de associação entre superexpressão de c-erbB-2 e sítio do tumor, em que casos positivos ocorreram com mais freqüência no terço médio do esôfago. Nenhuma correlação significativa foi verificada entre essas proteínas e sobrevida global. CONCLUSÃO: Os resultados podem sugerir um papel primordial para essas proteínas na diferenciação tumoral em CEE.
INTRODUCTION: Esophageal squamous cell carcinoma (ESCC) is highly prevalent in Brazil, and responsible for high mortality index. The epidermal growth factor receptor (EGFR) family has four members and much attention has been focused on the expressions of EGFR and c-erbB-2 with therapeutic implications. OBJECTIVE: The aim of the present study was to investigate immunohistochemical expressions of c-erbB-2 and EGFR in ESCC, and correlate them with clinicopathological data. MATERIAL AND METHODS: Medical records of 613 patients with ESCC were reviewed. Immunohistochemistry was carried out using polyclonal c-erbB-2 and monoclonal EGFR in 597 and 585 cases, respectively. Cases represented by surgical resections were performed in three tissue microarray (TMA) paraffin blocks spotted in duplicate; those with small biopsies without surgical resections were performed individually. All cases were scored according to intensity and pattern of membrane staining of tumor cells. RESULTS: The expressions of c-erbB-2 and EGFR were observed in 42.4 percent and 77.6 percent of the cases, respectively. A significant correlation was found between c-erbB-2 (p = 0.04) and EGFR (p = 0.01) expressions and histological grade. Both markers were significantly more expressed in well/moderate differentiated ESCC than in poorly differentiated ESCC. Although it was not significant, there was a tendency of association between c-erbB-2 overexpression and tumor location, in which positive cases occurred more frequently in the middle third of the esophagus. There was no correlation with overall survival. CONCLUSION: The results may suggest a role for these markers in tumoral differentiation in ESCC.