ABSTRACT
OBJETIVO: Avaliar a influência de fatores anatomopatológicos como prognóstico na sobrevida de pacientes operados de adenocarcinoma colorretal. MÉTODOS: Estudo tipo coorte histórica aberta, baseado na análise de 119 pacientes operados de adenocarcinoma colorretal com intenção curativa no Hospital Universitário Júlio Muller, no período de 1984 a 2002. Os dados foram obtidos dos prontuários médicos e de exames anatomopatológicos revisados, sendo submetidos à análise estatística de sobrevida em cinco anos pelo método de Kaplan & Méier. O reto foi o segmento mais acometido em 44,5 por cento dos casos. O aspecto macroscópico tumoral predominante foi o ulcerado ou infiltrante (50,4 por cento), com tamanhos entre 2 e 17 cm, sendo que a maioria dos tumores (64,7 por cento) infiltrava até a camada serosa. O número médio de linfonodos analisados foi de 11,8(±7,3) por peça cirúrgica, indentificando-se nestes, 42,8 por cento de metástases. A maioria dos tumores (85,4 por cento) era bem ou moderadamente diferenciada. Foram observadas embolização angiolinfática e perineural em respectivamente 51,2 por cento e 23,5 por cento. RESULTADOS: Não houve significância estatística quanto a morfologia (p=0,87), tamanho do tumor (p=0,56) e grau de diferenciação celular (p=0,83). Os fatores que se correlacionaram com a sobrevida foram o sítio do tumor primário (p=0,04), a invasão angiolinfática intra-tumoral (p=0,02), invasão perineural (p<0,01), a infiltração das camadas (p=0,02), e o comprometimento linfonodal (p<0,01). CONCLUSÃO: A análise dos fatores anatomopatológicos mostrou correlação significativa da sobrevida com o sítio primário, a camada acometida, invasão perineural, invasão angiolinfática e comprometimento dos linfonodos.
BACKGROUND: The aim of this study was to evaluate the influence of the pathological aspects as prognostic for survival in patients who underwent resection for colorectal adenocarcinoma. METHOD: A historical cohort study was conducted based on an analysis of 119 patients with colorectal adenocarcinoma submitted to curative intention resection at the Department of Surgery of the Júlio Müller University Hospital from 1984 to 2002. Data were obtained from medical records. Specimen slides were reviewed and the findings were submitted to the survival analysis using the Kaplan-Meier method. The rectum was the location most frequent found (44,5 percent). The predominant macroscopic aspect was ulcerated or infiltrate type (50,4 percent), with lengths between 2 and 17 cm, and the majority of the tumors (64,7 percent) infiltrated until the serosa layer. The average number of lymph nodes examined in the surgical specimen was 11,8(±7,3) showing 42,8 percent of metastatic envolviment. Most of the tumors (85,4 percent) were categorized as either well or moderately differentiated. Angiolymphatic embolization and perineural invasion were observed in 51,2 percent and 23,5 percent respectively. RESULTS: There was no statistical significance of survival with morphology (p=0,87), length of the tumor (p=0,56) and degree of cellular differentiation (p=0,83). The factors that correlated with survival were location of the tumor (p=0,04), angiolymphatic embolization (p=0,02), perineural invasion (p <0,01), wall infiltration (p=0,02), and lymph node involvement (p <0.01). CONCLUSION: Survival of patients operated for colorectal adenocarcinoma showed significant correlation with site of the tumor, extension through gut layers, angiolymphatic embolization, perineural invasion, and lymphonodal involvement.
ABSTRACT
This is the report of a rare case of endomyocardial fibrosis associated with massive calcification of the left ventricle in a male patient with dyspnea on great exertion, which began 5 years earlier and rapidly evolved. Due to lack of information and the absence of clinical signs that could characterize impairment of other organs, the case was initially managed as a disease with a pulmonary origin. With the evolution of the disease and in the presence of radiological images of heterogeneous opacification in the projection of the left ventricle, the diagnostic hypothesis of endomyocardial disease was established. This hypothesis was later confirmed on chest computed tomography. The patient died on the 16th day of the hospital stay, probably because of lack of myocardial reserve, with clinical findings of refractory heart failure, possibly aggravated by pulmonary infection. This shows that a rare disease such as endomyocardial fibrosis associated with massive calcification of the left ventricle may be suspected on a simple chest X-ray and confirmed by computed tomography.