Esôfago de Barrett: o estado da arte / Barrett's Esophagus: the state of the art

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable

Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Tratamiento con radioterapia quimioterapia neoadyuvante vs adyuvante en adenocarcinomade recto: experiencia de 15 años / Treatment with neoadjuvant chemotherapy vs adjuvant in rectum adenocarcinoma: 15 years' experience

Experiencia 15 años tratamiento neoadyuvante vs., adyuvante ADC recto. MÉTODO: 223 pacientes ADC recto tratamiento RT QT período 2000-2015, divididos 3 grupos: 1. Tratamiento adyuvante (110), 2. ratamiento neoadyuvante (93), 3. Tratamiento neoadyuvante no operados (20). RT administrada técnica conformada 3D todos los pacientes excepto 3 RT intensidad modulada, dosis 4 500-4 600 cGy fracciones diarias 180-200 cGy, a pelvis técnica 4 campos, reducción sitio lesión macroscópica (RT neoadyuvante) o áreade nastomosis (RT adyuvante) 5 000-5 040 cGy. Esquemas QT más utilizados 5FU, 5FU-leucovorina, capecitabina sola o combinación oxaliplatino. RESULTADOS: Mayoría estadio III, mayor IIIB grupo neoadyuvante, 44 % vs. 30 % grupo adyuvante. Sobrevida global 5 años grupo RT-QT adyuvante 69,03 % vs. 81,24 % grupo RT-QT neoadyuvante, resultado no estadísticamente significativo (P=0,37) sobrevida libre enfermedad 5 años 80 % grupo RT-QT neoadyuvante vs. 56 % pacientes grupo RT-QT adyuvante, diferencia estadísticamente significativa (P=0,000392). 20 tratamiento neoadyuvante no cirugía, sobrevida global 5 años 50 %, resultados inferiores a tratamiento adyuvante y neoadyuvante. 59,2 % grupo neoadyuvante 86,4 % adyuvante se pudo preservar el esfínter. Toxicidad aguda más frecuente gastrointestinal, grado II-III, mayor grupo adyuvante (57 % vs. 45 %). Complicaciones crónicas GI, grado III, 2 pacientes grupo adyuvante 1 grupo neoadyuvante, grado IV. 2 grupo adyuvante 1 neoadyuvante. CONCLUSIONES: En 223 pacientes ADC recto, no se encontraron diferencias significativas SG tratamiento adyuvante vs., neoadyuvante pero SLE fue superior grupo tratamiento neoadyuvante. Toxicidad parece menor con tratamiento preoperatorio(AU)

OBJECTIVE: 15 years' experience treatment ADC rectal with adjuvant RT-CT vs., neoadjuvant RT-CT. METHOD: 223 patients rectal ADC treated with RT-CT surgery, during 2000-2015. Divided 3 groups: 1. Adjuvant therapy (110). 2. Neoadjuvant therapy (93) 3. Neoadjuvant therapy without surgery (20). Three D conformal RT used all patients except 3 treated with intensity modulated RT, doses 4 500-4 600 with 180-200 cGy daily fractions pelvis 4 field technique, 5 000- 5 040 cGy boost rectal tumor or the anastomosis. Chemotherapy more frequently was 5FU, 5FU-leucovorin, capecitabine alone or oxaliplatin. RESULTS: Majority stage III, IIIB was more frequent neoadjuvant group, 44 % vs., 30 % adjuvant group. 5 years overall survival was 69.03 % adjuvant RT-CT vs. 81.24 % with neoadjuvant RT-QT (P=0.37 disease free survival was higher neoadjuvant therapy, 80 % vs. 56 %, (P=0.000392). 20 treated neoadjuvant RT-CT no surgery, had 50 % OS 5 years, lower than adjuvant or neoadjuvant therapy. Grade II-III acute gastrointestinal toxicity was more common in patients with adjuvant therapy, 57 % vs. 45 % neoadjuvant therapy. One patient in each group grade IV, acute GI toxicity. Chronic grade III GI toxicity occurred, 2 with adjuvant therapy one neoadjuvant therapy, grade IV also 1 patient with preoperative RT-CT in 2 postoperative RT-CT. CONCLUSIONS: 223 rectal ADC, did not show significant difference in OS between adjuvant RT-CT and neoadjuvant RT-CT but DFS was higher with preoperative therapy. Toxicity seems lower in group treated with neoadjuvant therapy(AU)

Effects of zinc supplementation on fatigue and quality of life in patients with colorectal cancer / Efeitos da suplementação de zinco na fadiga e na qualidade de vida de pacientes com câncer colorretal

ABSTRACT Objective To investigate the effects of oral zinc supplementation on fatigue intensity and quality of life of patients during chemotherapy for colorectal cancer. Methods A prospective, randomized, double-blinded, placebo-controlled study was conducted with 24 patients on chemotherapy for colorectal adenocarcinoma in a tertiary care public hospital. The study patients received zinc capsules 35mg (Zinc Group, n=10) or placebo (Placebo Group, n=14) orally, twice daily (70mg/day), for 16 weeks, from the immediate postoperative period to the fourth chemotherapy cycle. Approximately 45 days after surgical resection of the tumor, all patients received a chemotherapeutic regimen. Before each of the four cycles of chemotherapy, the Functional Assessment of Chronic Illness Therapy-Fatigue scale was completed. We used a linear mixed model for longitudinal data for statistical analysis. Results The scores of quality of life and fatigue questionnaires were similar between the groups during the chemotherapy cycles. The Placebo Group presented worsening of quality of life and increased fatigue between the first and fourth cycles of chemotherapy, but there were no changes in the scores of quality of life or fatigue in the Zinc Group. Conclusion Zinc supplementation prevented fatigue and maintained quality of life of patients with colorectal cancer on chemotherapy.

RESUMO Objetivo Investigar os efeitos da suplementação oral de zinco sobre a intensidade da fadiga e a qualidade de vida de pacientes durante a quimioterapia para neoplasia colorretal. Métodos Estudo prospectivo, randomizado, controlado e duplo-cego conduzido em um hospital universitário público terciário, com 24 pacientes em regime quimioterápico para adenocarcinoma colorretal. Os pacientes receberam cápsulas de zinco 35mg (Grupo Zinco, n=10) ou placebo (Grupo Placebo, n=14) por via oral, duas vezes ao dia (70mg/dia), durante 16 semanas, desde o período pós-operatório imediato até o quarto ciclo de quimioterapia. Todos os pacientes receberam quimioterapia por aproximadamente 45 dias após a ressecção cirúrgica do tumor. A escala Functional Assessment of Chronic Illness Therapy-Fatigue foi preenchida antes de cada um dos quatro ciclos de quimioterapia. Utilizou-se o modelo de regressão linear misto para dados longitudinais para análise estatística. Resultados Os escores de qualidade de vida e de fadiga foram semelhantes entre os grupos de estudo durante os ciclos de quimioterapia. O Grupo Placebo apresentou piora da qualidade de vida e da fadiga entre o primeiro e o quarto ciclos de quimioterapia, mas não houve mudança nos escores de qualidade de vida e fadiga no Grupo Zinco. Conclusão A suplementação com zinco previne a fadiga e preserva a qualidade de vida de pacientes em quimioterapia para neoplasia colorretal.

Características clínicas, epidemiológicas y anatomopatológicas de los adenocarcinomas del tracto gastrointestinal en menores de 18 años en el Instituto Nacional de Enfermedades Neoplásicas del Perú durante el periodo 1997-2012 / Characteristics clinical, epidemiological and pathological of the adenocarcinomas of the gastrointestinal tract in children less than 18 years at the National Institute of Neoplastic Diseases of Peru during the period 1997-2012

Los adenocarcinomas gastrointestinales son un grupo de neoplasias que tiene su origen en las células que constituyen el revestimiento interno de las glándulas de secreción externa del tracto gastrointestinal, es un tipo de crecimiento celular maligno producido por la proliferación de células anormales con capacidad de invasión y destrucción de otros tejidos y órganos. En las formas metastásicas, las células tumorales pueden infiltrar los vasos linfáticos de los tejidos, diseminarse a los ganglios y, sobrepasando esta barrera, penetrar en la circulación sanguínea, después de lo cual queda abierto virtualmente el camino a cualquier órgano del cuerpo. Al ser neoplasias muy raras en la edad pediátrica se dificulta tener una casuística suficiente para determinar las mejores conductas terapéuticas y se desconoce en nuestro medio de estadísticas fidedignas que reflejen la real magnitud del problema y por ello se hacen necesarios estudios descriptivos que puedan ser base de estudios posteriores. Nuestro objetivo es determinar las características clínicas, epidemiológicas y anatomopatológicas de los adenocarcinomas del tracto gastrointestinal en el Instituto Nacional de Enfermedades Neoplásicas en menores de 18 años durante el periodo 1997 a 2012...

Role of the extracellular matrix in variations of invasive pathways in lung cancers

Among the most common features of highly invasive tumors, such as lung adenocarcinomas (AD) and squamous cell carcinomas (SqCC), is the massive degradation of the extracellular matrix. The remarkable qualitative and quantitative modifications of hyaluronidases (HAases), hyaluronan synthases (HAS), E-cadherin adhesion molecules, and the transforming growth factor β (TGF-β) may favor invasion, cellular motility, and proliferation. We examined HAase proteins (Hyal), HAS, E-cadherin, and TGF-β profiles in lung AD subtypes and SqCC obtained from smokers and non-smokers. Fifty-six patients, median age 64 years, who underwent lobectomy for AD (N = 31) and SqCC (N = 25) were included in the study. HAS-1, -2 and -3, and Hyal-1 and -3 were significantly more expressed by tumor cells than normal and stroma cells (P < 0.01). When stratified according to histologic types, HAS-3 and Hyal-1 immunoreactivity was significantly increased in tumor cells of AD (P = 0.01) and stroma of SqCC (P = 0.002), respectively. Tobacco history in patients with AD was significantly associated with increased HAS-3 immunoreactivity in tumor cells (P < 0.01). Stroma cells of SqCC from non-smokers presented a significant association with HAS-3 (P < 0.01). Hyal, HAS, E-cadherin, and TGF-β modulate a different tumor-induced invasive pathway in lung AD subgroups and SqCC. HAases in resected AD and SqCC were strongly related to the prognosis. Therefore, our findings suggest that strategies aimed at preventing high HAS-3 and Hyal-1 synthesis, or local responses to low TGF-β and E-cadherin, may have a greater impact in lung cancer prognosis.

Estado atual do tratamento cirúrgico do adenocarcinoma gástrico avançado / Current status of surgical treatment of advanced gastric adenocarcinoma

A evolução da complexidade do manejo atual do câncer gástrico tornou necessário o envolvimento de uma equipe multidisciplinar para o seu tratamento. Cirurgiões, oncologistas, gastroenterologistas, endoscopistas, patologistas, radiologistas e radioterapeutas, auxiliados por nutricionistas, assistentes sociais, enfermeiros e fisioterapeutas, entre outras especialidades de apoio, estão envolvidos na difícil tarefa de adequar as melhores escolhas terapêuticas, individualizando as necessidades dos pacientes. A ressecção cirúrgica do tumor permanece como a única opção curativa nessa neoplasia. Nos últimos 20 anos ocorreram calorosos debates na literatura sobre o melhor procedimento cirúrgico para os pacientes com esse tumor. A extensão da ressecção gástrica, a necessidade da remoção de outros órgãos e principalmente a extensão da linfadenectomia foram amplamente estudados. Portanto, o fato do cirurgião ser um dos principais fatores prognósticos no tratamento do adenocarcinoma gástrico justifica uma revisão atualizada sobre o tema.

The increased complexity of the current management of gastric cancer has dictated the need for the involvement of a multidisciplinary team for its treatment. Surgeons, oncologists, gastroenterologists, endoscopists, pathologists, radiologists and radiation oncologists, assisted by dietitians, social workers, nurses and physical therapists and other support specialists are all engaged in the difficult task of tailoring the best therapeutic choices and thus individualizing patient needs. Surgical resection of the tumor still remains the only curative option in this neoplasm. Over the past 20 years there has been a heated debate in the literature about the best surgical procedure for patients with this tumor. The extent of gastric resection, the need for removal of other organs, and in particular the extent of lymphadenectomy have been extensively studied. Therefore, the fact that the surgeon is a major prognostic factor in the treatment of gastric cancer warrants an updated review on the subject.

Evolução do status de performance, índice de massa corpórea e distância percorrida no teste de caminhada de seis minutos em pacientes com câncer de pulmão avançado submetidos à quimioterapia / Evolution of performance status, body mass index, and six-minute walk distance in advanced lung cancer patients undergoing chemotherapy

OBJETIVO: Avaliar o efeito da quimioterapia sobre a condição física de pacientes com câncer de pulmão avançado. MÉTODOS: Foram avaliados 50 pacientes com câncer de pulmão não pequenas células nos estágios IIIB e IV e com status de performance segundo a escala do Eastern Cooperative Oncology Group (ECOG) entre zero e dois. Todos receberam quimioterapia com as drogas paclitaxel e derivados da platina e foram avaliados em três momentos (pré-quimioterapia, pós-quimioterapia e seis meses após o início do tratamento), nos quais a escala ECOG, o índice de massa corpórea (IMC) e a Distância percorrida no Teste de Caminhada de Seis minutos (DTC6) foram avaliados. RESULTADOS: Dos 50 pacientes incluídos, 14 foram a óbito, 5 foram excluídos do estudo por apresentar piora do status de performance, e 31 concluíram o seguimento de seis meses. Não houve diferença estatisticamente significativa para o IMC (p = 1,00, pré-quimioterapia vs. pós-quimioterapia; e p = 0,218, pré-quimioterapia vs. seis meses após) ou para a DTC6 entre os momentos de avaliação. O status de performance melhorou, principalmente com o aumento do número de pacientes assintomáticos após seis meses de acompanhamento (p = 0,031). CONCLUSÕES: O uso de quimioterapia teve um efeito benéfico no status de performance dos pacientes. Não houve alterações no IMC ou na DTC6 durante o período do estudo, o que pode sugerir a manutenção da condição física dos pacientes.

OBJECTIVE: To evaluate the effect of chemotherapy on the physical condition of patients with advanced lung cancer. METHODS: We evaluated 50 patients with non-small cell lung cancer (in stages IIIB and IV) and Eastern Cooperative Oncology Group (ECOG) performance status scale scores between zero and two. All patients underwent chemotherapy using paclitaxel and platinum derivatives and were evaluated at three time points (prechemotherapy, postchemotherapy and six months after starting the treatment), at which the ECOG scale, the body mass index (BMI) and the six-minute walk distance (6MWD) were assessed. RESULTS: Of the 50 patients included in the study, 14 died, 5 were excluded due to the worsening of their performance status, and 31 completed the six-month follow-up. There was no statistically significant difference between the time points of assessment for BMI (prechemotherapy vs. postchemotherapy, p = 1.00; and prechemotherapy vs. six months later, p = 0.218) or for 6MWD. Performance status improved, and this was especially due to the increase in the number of asymptomatic patients after the six-month follow-up (p = 0.031). CONCLUSIONS: Chemotherapy had a beneficial effect on the performance status of the patients. No significant changes in BMI or 6MWD were found during the study period, which might suggest the maintenance of the physical condition of the patients.

From two-dimensional to three-dimensional conformal radiotherapy in prostate cancer: An Indian experience.

Background: Sparse data from India are available regarding the outcome of prostate cancer treatment. We report our experience in treating prostate cancer with radiotherapy (RT). Materials and Methods: This study included 159 men with locally advanced cancer treated with RT with or without hormone therapy between 1984 and 2004. The median RT dose was 70 Gy over 35 fractions. Eighty-five patients received whole pelvic RT and prostate boost, and 74 patients were treated with 3-dimensional conformal radiotherapy (3DCRT) to prostate and seminal vesicles alone. Results: The median follow-up was 25 months and the freedom from biochemical failure for all the patients at 5 years was 76%, disease-free survival (DFS) 59.1%, and overall survival (OAS) was 70.1%. The risk stratification (91% vs 52%, P < 0.03) and RT dose (72.8% for dose > 66 Gy vs 43.5% for dose < 66 Gy; P = 0.01) affected the DFS. DFS at 5 years was better in the group receiving 3DCRT to prostate and seminal vesicles (78% vs 51.5%; P = 0.001) and was reflected in OAS as well (P = 0.01). Conclusion: CRT technique with dose escalation results in significant benefit in DFS and OAS in locally advanced prostate cancer.

Association of gastric cancer incidence with MDR1 gene polymorphism in an ethnic Iranian population.

Background: The allele frequency of the multidrug resistance 1 (MDR1) gene C3435T polymorphism differs with different ethnic populations, such as Asian, African, and Caucasian. This polymorphism has been reported to be associated with the increase of gastric cancer. Objectives: The objective of this study was to find out the association of gastric cancer incidence with MDR1 gene polymorphism in an ethnic Iranian population. Materials and Methods: In this study, 48 gastric cancer patients were diagnosed. Genomic DNA was extracted by a salting-out method. The MDR1 polymorphism was studied by a polymerase chain reaction (PCR)-restriction fragment length polymorphism method, using a standard method. Results: The polymorphic homozygote (T/T) genotype showed significantly an association with the incidence of gastric cancer compared with controls (P < 0.05). Conclusions: This study suggests that C3435T polymorphism of the MDR1 gene may be associated with gastric cancer in an ethnic Iranian population.

Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey / Assessment of the quality of life of patients with lung cancer using the Medical Outcomes Study 36-item Short-Form Health Survey

OBJETIVO: Avaliar a qualidade de vida de pacientes com câncer de pulmão e compará-la com a qualidade de vida de indivíduos sem câncer. MÉTODOS: O questionário Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) foi aplicado em 57 pacientes com diagnóstico de câncer de pulmão provenientes do Ambulatório de Oncopneumologia do Hospital São Paulo e em um grupo controle de 57 indivíduos participantes do Grupo de Ginástica Extra Penha. O teste de Mann-Whitney foi utilizado para comparar cada domínio entre os grupos. O primeiro modelo de regressão logística foi ajustado para sexo masculino, tratamento não cirúrgico, índice de Karnofsky e tabagismo, que foram incluídos como preditores. O segundo modelo foi ajustado para cada domínio do SF-36 para identificar aumento na proporção de estádios IIIB e IV. RESULTADOS: O grupo com câncer de pulmão e o grupo controle apresentaram, respectivamente, as seguintes pontuações médias para os domínios do SF-36: aspectos físicos, 29,39 ± 36,94 e 82,89 ± 28,80; aspectos emocionais, 42,78 ± 44,78 e 86,55 ± 28,77; capacidade funcional, 56,49 ± 28,39 e 89,00 ± 13,80; vitalidade, 61,61 ± 23,82 e 79,12 ± 17,68; dor, 62,72 ± 28,72 e 81,54 ± 19,07; estado geral de saúde, 62,51 ± 25,57 e 84,47 ± 13,47; saúde mental, 68,28 ± 23,46 e 82,63 ± 17,44; e aspectos sociais, 72,87 ± 29,20 e 91,67 ± 17,44. O modelo de regressão logística demonstrou que aspectos físicos, capacidade funcional e saúde mental foram preditores de estádios IIIB e IV. CONCLUSÕES: Os pacientes com câncer de pulmão apresentaram pior qualidade de vida em relação ao grupo controle, principalmente em relação aos aspectos físicos.

OBJECTIVE: To assess the quality of life of patients with lung cancer and to compare it with that of individuals without cancer. METHODS: The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was administered to 57 patients diagnosed with lung cancer, treated at the Lung Cancer Outpatient Clinic of the Hospital São Paulo, and to a control group of 57 individuals recruited from the Extra Penha workout group. The Mann-Whitney test was used to compare the groups, domain by domain. The first model of logistic regression was adjusted for male gender, nonsurgical treatment, Karnofsky performance status and smoking, which were included as predictors. The second model was adjusted for each SF-36 domain in order to identify increases in the proportions of patients in stage IIIB or IV. RESULTS: The lung cancer group and the control group presented the following mean scores, respectively, for the SF-36 domains: role limitations due to physical health problems, 29.39 ± 36.94 and 82.89 ± 28.80; role limitations due to emotional problems, 42.78 ± 44.78 and 86.55 ± 28.77; physical function, 56.49 ± 28.39 and 89.00 ± 13.80; vitality, 61.61 ± 23.82 and 79.12 ± 17.68; bodily pain, 62.72 ± 28.72 and 81.54 ± 19.07; general health, 62.51 ± 25.57 and 84.47 ± 13.47; emotional well-being, 68.28 ± 23.46 and 82.63 ± 17.44; and social functioning, 72.87 ± 29.20 and 91.67 ± 17.44. The logistic regression model showed that role limitations due to physical health problems, physical function and emotional well-being were predictors of stages IIIB and IV. CONCLUSIONS: The patients with lung cancer had a poorer quality of life, especially regarding physical aspects, than did the control subjects.

Las hormonas esteroides y el páncreas: Un nuevo paradigma / Steroid hormones and pancreas: A new paradigm

The relation between steroid hormones and pancreatic function has been poorly discussed and not very well understood. In general, there is a lack of recognition among the scientific community about the importance of steroids in pancreatic function (current paradigm). In the present article we present basic, as well as clinic and epidemiologic data that demonstrate steroid synthesis and steroid biotransformation by pancreatic tissue, how exocrine and endocrine functions are modulated by steroids, the gender specific frequency and behavior of some tumors and the use of synthetic steroids and steroid action antagonists as therapeutic agents. With the available information it is possible to establish that: 1. Pancreatic tissue synthesize and transform steroid hormones. 2. Pancreatic tissue respond to steroid hormones and express steroid specific receptor molecules. 3. Some endocrine functions such as insulin synthesis and release are modulated by steroids. 4. Tumor growth is modulated by steroids and anti-steroid drugs. This set of data creates a new paradigm for the holistic study of pancreas and opens new research fields. The application of this new paradigm might result in an increase in the knowledge of pancreatic physiology, in the design of new and better diagnostic methods and eventually in the design of more effective medical treatments for the pancreatic cancers.

La relación de las hormonas esteroides con el páncreas ha sido muy poco explorada y comprendida y no se concede en general que exista una interacción relevante entre su función y los esteroides endógenos o exógenos (paradigma actual). En esta revisión se presentan datos de modelos experimentales y de estudios clínicos y epidemiológicos que demuestran que existe una clara relación entre la biotransformación y el efecto de las hormonas esteroides y la fisiopatología del páncreas. Con la información disponible se puede establecer que: 1. El páncreas es un órgano que sintetiza y transforma hormonas esteroides. 2. Que expresa receptores específicos para este tipo de substancias. 3. Que algunas de sus funciones como la síntesis y liberación de la insulina pueden ser modulados por la acción de esteroides gonadales. 4. Que el crecimiento tumoral puede ser inducido o frenado por la acción de esteroides y antiesteroides. Estas relaciones establecen un nuevo paradigma en el estudio de la fisiopatología del páncreas y abren nuevas líneas de investigación para el avance del conocimiento y su eventual aplicación clínica.

Management of endobronchial cancer using bronchoscopic electrocautery.

From December 2004 until November 2005, 15 cases of endobronchial cancer presenting with 22 episodes of mechanical obstruction of the airway, difficulty in breathing, hemoptysis, severe coughing, obstructive pneumonia and identified recurrent atelectasis of the lungs. The cancer was removed rapidly, effectively and without complication by a technique of fiberoptic bronchoscopic electrocautery.

Câncer de próstata: avaliação de aspectos histopatológicos prognósticos em espécimes de prostatectomia radical com ênfase nas diferenças entre os adenocarcinomas gleason 7(4+3) e 7(3+4) / Cancer of the prostate: evaluation of histopathological prognostic aspects in specimens of radical prostatectomy with emphasis on differences between adenocarcinomas gleason 7 (4+3) and 7 (3+4)

O adenocarcinoma da próstata é a terceira causa mais freqüente de óbito por câncer em pacientes acima de 55 anos de idade e a principal em homens acima de 75 anos. Os fatores considerados prognósticos deste carcinoma são nível de PSA, grau histológico (Gleason), estadiamento, margens cirúrgicas e tamanho do tumor. Contudo, o tamanho do tumor como fator prognóstico de recorrência é controverso na literatura. No presente trabalho estudaram-se as relações entre o PSA pré-operatório, comprometimento de vesículas seminais (pT3b ou superior), o grau histológico, a extensão extra prostática, as margens cirúrgicas com a extensão do tumor, o Gleason 7 (3+4) versus 7 (4+3) e a proliferação celular em 48 espécimes de prostatectomia radical devido a adenocarcinoma da próstata nos serviços de anatomia patológica do Hospital Professor Edgard Santos (Hospital das Clínicas de Salvador - BA), CLlNNAZA@ - Clinica Nazaré e Serviço de Oncologia da Bahia (CICAN), no período entre 2000 e 2003. No nosso estudo houve uma relação estatisticamente significante quando correlacionamos o percentual de comprometimento da glândula por tumor com o nível de PSA pré-operatório, parâmetros histopatológicos e índice de proliferação celular...

Sonographic and colour doppler morphology in carcinoma gallbladder.

Conventional radiography has limitations in accurate diagnosis of gallbladder cancer (GBC). Ultrasonography (USG) allows correct diagnosis in 70-80% advanced and 23% early GBC. Present study was initiated to identify morphology and flow characteristics in GBC using conventional USG and Colour Doppler USG (CD-USG). In 100 patients, USG assessed morphology of mass lesion/wall thickening together with associated features. Of these, 60 cases were studied using CD-USG for intralesional/perilesional vascularity, peak systolic flow velocity (V max), resistive index (RI) and pulsatility index (PI). USG identified GB with mass lesion in 44% cases (Group-I) and only mass in GB fossa in 56% cases (Group-II). Findings identified calculi (73%), liver infiltration (74%), intrahepatic ductal dilatation (IHDD) (52%), lymphadenopathy (19%) and ascites (5%). CD-USG revealed vascularity, mainly pulsatile flow, in 78.3% cases (in 91.3% Group-I cases). Mean Vmax was 0.3037 m/sec (0.109 - 0.646 m/sec.), mean RI was 0.6621 (0.526 - 1.000) and PI was 1.282 (0.772 -2.140), Mean Vmax and PI were higher in Group-I compared to Group-II. Presence of calculus in 73% cases suggests a high association between calculus and malignancy. As flow signals were seen in 78% of all cases and 91.3% Group-I cases undergoing CD-USG, USG and CD-USG together can improve pickup rate of GBC.

Correlaçäo das proteínas p53 e KI-67 com o prognóstico de pacientes com adenocarcinoma de reto distal / Correlation between p53 and KI-67 proteins and the follow-up of patients with rectum adenocarcinoma

Introduçäo: a capacidade de predizer o comportamento biológico e a resposta terapêutica seria de grande valia no tratamento do câncer de reto distal. Correlacionou-se a hiperexpressäo do p53 e Ki-67 com: parâmetros clinicopatológicos, resposta ao tratamento e prognóstico. Métodos: cortes histológicos de 72 pacientes com adenocarcinoma de reto distal foram corados para as proteínas p53 e Ki-67. Todos os pacientes receberam radioterapia (5.040cGy) e quimioterapia (5-fluorouracil+leucovorin). Os pacientes com resposta completa foram acompanhados sem tratamento cirúrgico, enquanto a ressecçäo foi realizada naqueles com resposta parcial. Resultados: hiperexpressäo do p53 foi detectada em 41/72 (56,9 por cento) tumores e alto índice de proliferaçäo (Ki-67) foi observado em 36/72 (50 por cento) tumores. Amostras teciduais coletadas pré e pós quimio/radioterapia apresentaram fidelidade no estado do p53 em todos os casos. Reatividade ao p53 e Ki-67 correlacionaram-se com recidiva da doença (p=0,02, p=0,006, respectivamente), contudo näo se associou com: idade, sexo, estádio T. N. M. e doença residual após quimio/radioterapia. Expressäo do p53 e Ki-67 associou-se com menor índice de sobrevivência geral (68,2 vs. 87,2 meses, p=0,005 e 59,9 vs. 89,3 meses, p=0,001, respectivamente) e intervalo livre de doença (59,4 vs. 81,7 meses, p=0,004 e 48,9 vs. 86,1 meses, p=0,0009, respectivamente). Conclusäo: as proteínas p53 e Ki-67 podem ser úteis na avaliaçäo prognóstica de pacientes com câncer de reto distal submetidos à terapia multimodal

Wound healing and colon carcinogenesis: enhancing effects of skin wounding on development of colon tumors induced by 1, 2 Dimethylhydrazine in the rat

This study demonstrates the tumor promoting effect at a distant site of skin wounding, in a model of colon carcinogenesis induced by 1,2 dimethylhydrazine (DMH) in the rat. Six-week-old male Wistar rats were given subcutaneous injections of DMH, 20mg/kg, or saline, once a week, for eight weeks. One week after the last DMH injection the animals received a full thickness skin wound in their dorsal skin and the wound was left open to heal by second intention. Control and DMH-treated rats, with or without skin wounds were killed at the 12th week, just after healing of the skin wound was complete. The colons were removed and divided into proximal and distal parts. Each segment was rolled as "Swiss roll"and processed for histology. The incidence, distribution and morphology of the colon tumors was recorded. The total number of tumors in the colonic mucosa and the number of tumors per rat was significantly higher in the skin-wounding DMH- treated group than in the unwounded group. In the histopathological analysis of the colon the number of poorly differentiated mucin-secreting carcinomas was 6-fold in the skin-wounding DMH-treated group than in the unwounded group and the majority of tumors were located near to lymphoid aggregates. The present results suggest that wound healing enhances tumor development at a distant site, such as the colon, and this effect seems to be related to tumor histology.

Prevalencia del esófago de Barret y asociación con adenocarcinoma esofágico: experiencia de 25 años / Barrett's esophagus and cancer

Tradicionalmente el esófago de Barrett (EB) ha sido asociado a la enfermedad por reflujo gastroesofágico (ERGE) grave y con el adenocarcinoma de esófago. Actualmente entre un 8 y 20 por ciento de los pacientes con sintomatología de reflujo que son sometidos a endoscopia presentan esófago de Barrett.1,2 El riesgo de malignización de éste es muy variable, estimándose porcentajes del 0 al 58 por ciento.3 El objetivo del estudio fue determinar la prevalencia, características clínicas, endoscópicas e histológicas del EB, además de su asociación con adenocarcinoma. Se realizó un estudio retrospectivo en 520 pacientes de los cuales a 78 se les diagnóstico EB (prevalencia 15 por ciento) (71.7 del sexo masculino y 28.2 por ciento femenino, con una relación 3:1; edades de 9 a 89 años (media 65 años). El 94.8 por ciento presentó datos clínicos de ERGE. Los principales hallazgos endoscópicos fueron ulceraciones (32.0 por ciento) y estenosis (21.7 por ciento). Los estudios histológicos demostraron epitelio de tipo intestinal en 42.3 por ciento y fúndico en 8.9 por ciento. Se presentó displasia leve en 6.4 por ciento, y severa 1.2 por ciento. La asociación de adenocarcinoma de la unión esofagogástrica y el EB adyacente en el estudio histológico inicial fue 5.1 por ciento, otros dos casos con EB evolucionaron a adenocarcinoma lo que da 6.4 por ciento. El periodo de seguimiento fue de 2 a 9 años (media 11 meses). Conclusión; la prevalencia del EB en nuestra población es similar a la reportada en la literatura mundial, la incidencia y prevalencia de malignización del EB en nuestro medio es baja, lo cual podría explicarse por ser corto el periodo de seguimiento.