Clinical features and management of women with borderline ovarian tumors in a single center in Brazil / Características clínicas e manejo de mulheres com tumores borderline de ovário em um hospital no Brasil

Abstract Objective The aim of the present study was to describe and analyze data of 57 women with borderline ovarian tumors (BOTs) regarding histological characteristics, clinical features and treatment management at the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas (Unicamp, in the Portuguese acronym). Methods The present retrospective study analyzed data obtained from clinical and histopathological reports of women with BOTs treated in a single cancer center between 2010 and 2018. Results A total of 57 women were included, with a mean age of 48.42 years old (15.43- 80.77), of which 30 (52.63%) were postmenopausal, and 18 (31.58%) were < 40 years old. All of the women underwent surgery. A total of 37 women (64.91%) were submitted to complete surgical staging for BOT, and none (0/57) were submitted to pelvic or paraortic lymphadenectomy. Chemotherapy was administered for two patients who recurred. The final histological diagnoses were: serous in 20 (35.09%) cases, mucinous in 26 (45.61%), seromucinous in 10 (17.54%), and endometrioid in 1 (1.75%) case. Intraoperative analyses of frozen sections were obtained in 42 (73.68%) women, of which 28 (66.67%) matched with the final diagnosis. The mean follow-up was of 42.79 months (range: 2.03-104.87 months). Regard ingthe current status of the women, 45(78.95%) are alive without disease, 2(3.51%) arealive with disease, 9 (15.79%) had their last follow-up visit > 1 year beforethe performanceof the present study but arealive, and 1 patient(1.75%) died of another cause. Conclusion Women in the present study were treated according to the current guidelines and only two patients recurred.

Resumo Objetivo O objetivo do presente estudo foi descrever uma série de 57 mulheres com tumores borderline de ovário (TBO) em relação às características histológicas, clínicas, e ao manejo do tratamento realizado no Departamento de Obstetrícia e Ginecologia da Universidade Estadual de Campinas (Unicamp). Métodos O presente estudo retrospectivo analisou dados obtidos dos registros clínicos e histopatológicos de mulheres com TBO tratadas em um único centro oncológico de 2010 a 2018. Resultados Um total de 57 mulheres foram incluídas, com uma média de idade de 48,42 anos (15,43-80,77), das quais 30 (52,63%) eram menopausadas, e 18 (31,58%) tinham < 40 anos. Todas as mulheres foram operadas. Um total de 37 mulheres (64,91%) foram submetidas a cirurgia de estadiamento completo para TBO, e nenhuma foi submetida a linfadenectomia pélvica ou paraórtica. O tratamento com quimioterapia foi administrado em duas pacientes que recidivaram. Os diagnósticos histológicos finais foram: seroso em 20 mulheres (35,09%), mucinoso em 26 (45,61%), seromucinoso em 10 (17,54%) e endometrióide em 1 (1,75%). A avaliação histológica intraoperatória foi realizada em 42 (73,68%) das mulheres, das quais 28 (66,67%) foram compatíveis com os diagnósticos finais. O tempo médio de seguimento foi de 42,79 meses (variando de 2,03 a 104,87 meses). Em relação ao status atual das mulheres, 45 (78.95%) estão vivas sem doença, 2 (3,51%) estão vivas com doença, 9 (15.79%) tiveram a última consulta de seguimento há > 1 ano antes da realização do presente estudo, mas estão vivas, e 1 paciente faleceu por outra causa. Conclusão As mulheres do presente estudo foram tratadas de acordo com as recomendações atuais e apenas duas mulheres apresentaram recorrência.

Social determinants of hospitalizations for ambulatory care sensitive conditions in Guarulhos, São Paulo / Los determinantes sociales de las hospitalizaciones por condiciones sensibles a la atención primaria en guarulhos, são paulo / Determinantes sociais das Internações por Condições Sensíveis à Atenção Primária em Guarulhos, São Paulo

The study goals present an overview of Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) in Guarulhos, SP, from 2008 to 2012. This is an ecological study based on secondary data obtained from the Brazilian Hospital Information System, and supported by the Praxical Theory of Intervention of Collective Health Nursing. Applied descriptive statistics for analysis. It was observed that Guarulhos shows an upward trend in hospitalizations by ACSC (20% increase), the most frequent causes of heart failure (11.8%), cerebrovascular disease (10.6%) and angina (9.7%), most frequently in the age group ≥ 65years old, for both sexes. The results are similar to other Brazilian studies, but their analysis should extrapolate the biological limits and the supply of healthcare resources, focusing on the social determinants of the health-disease process.


.

El estudio tuvo como objetivo proporcionar una visión general de las Hospitalizaciones por Condiciones Sensibles a la Atención Primaria (ICSAP) en Guarulhos, SP, en el período 2008-2012. Se trata de un estudio ecológico a partir de datos secundarios obtenidos a través del Sistema de Información Hospitalaria, y apoyado por la Teoría de Intervención Práxica de la Enfermería en Salud Colectiva. Se aplicó la estadística descriptiva para el análisis. Se observó que Guarulhos muestra una tendencia al alza en las hospitalizaciones por ICSAP (aumento del 20%), las causas más frecuentes de insuficiencia cardiaca (11,8%), enfermedad cerebrovascular (10,6%) y la angina (9,7% ), con mayor frecuencia en el grupo de edad ≥ 65 años para ambos sexos. Los resultados son similares a otros estudios brasileños, pero su análisis debe extrapolar los límites biológicos y el suministro de los recursos sanitarios, centrándose en los determinantes sociales del proceso salud-enfermedad.
.

Objetivo Apresentar o panorama das Internações por Condições Sensíveis à Atenção Primária (ICSAP) no município de Guarulhos, SP, no período de 2008 a 2012. Método Estudo ecológico, com dados secundários obtidos via Sistema de Informações Hospitalares, sustentado pela Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva. Empregou-se estatística descritiva para análise. Resultados Observou-se que Guarulhos apresenta trajetória crescente nas internações por ICSAP (aumento de 20%), sendo as causas mais frequentes a insuficiência cardíaca (11,8%), as doenças cerebrovasculares (10,6%) e a angina (9,7%), com maior frequência na faixa etária ≥ 65 anos, para ambos os sexos. Conclusão Os resultados encontrados assemelham-se a outros estudos brasileiros, porém sua análise deve extrapolar os limites biológicos e a oferta de recursos assistenciais, atentando para as determinações sociais do processo saúde-doença. .

Protein microarray for complex apoptosis monitoring of dysplastic oral keratinocytes in experimental photodynamic therapy

BACKGROUND: Photodynamic therapy is an alternative treatment of muco-cutaneous tumors that uses a light source able to photoactivate a chemical compound that acts as a photosensitizer. The phthalocyanines append to a wide chemical class that encompasses a large range of compounds; out of them aluminium-substituted disulphonated phthalocyanine possesses a good photosensitizing potential. RESULTS: The destructive effects of PDT with aluminium-substituted disulphonated phthalocyanine are achieved by induction of apoptosis in tumoral cells as assessed by flow cytometry analysis. Using protein microarray we evaluate the possible molecular pathways by which photodynamic therapy activates apoptosis in dysplastic oral keratinocytes cells, leading to the tumoral cells destruction. Among assessed analytes, Bcl-2, P70S6K kinase, Raf-1 and Bad proteins represent the apoptosis related biomolecules that showed expression variations with the greatest amplitude. CONCLUSIONS: Up to date, the intimate molecular apoptotic mechanisms activated by photodynamic therapy with this type of phthalocyanine in dysplastic human oral keratinocytes are not completely elucidated. With protein microarray as high-throughput proteomic approach a better understanding of the manner in which photodynamic therapy leads to tumoral cell destruction can be obtained, by depicting apoptotic molecules that can be potentially triggered in future anti-tumoral therapies.

In vivo effects of adenosine 5´-triphosphate on rat preneoplastic liver / Efecto in vivo de adenosina 5´-trifosfato sobre el hígado preneoplásico de la rata

The utilization of adenosine 5´-triphosphate (ATP ) infusions to inhibit the growth of some human and animals tumors was based on the anticancer activity observed in in vitro and in vivo experiments, but contradictory results make the use of ATP in clinical practice rather controversial. Moreover, there is no literature regarding the use of ATP infusions to treat hepatocarcinomas. The purpose of this study was to investigate whether ATP prevents in vivo oncogenesis in very-early-stage cancer cells in a well characterized two-stage model of hepatocarcinogenesis in the rat. As we could not preclude the possible effect due to the intrinsic properties of adenosine, a known tumorigenic product of ATP hydrolysis, the effect of the administration of adenosine was also studied. Animals were divided in groups: rats submitted to the two stage preneoplasia initiation/promotion model of hepatocarcinogenesis, rats treated with intraperitoneal ATP or adenosine during the two phases of the model and appropriate control groups. The number and volume of preneoplastic foci per liver identified by the expression of glutathione S-transferase placental type and the number of proliferating nuclear antigen positive cells significantly increased in ATP and adenosine treated groups. Taken together, these results indicate that in this preneoplastic liver model, ATP as well as adenosine disturb the balance between apoptosis and proliferation contributing to malignant transformation.

La utilización de adenosina 5´-trifosfato (ATP ) para inhibir el crecimiento de algunos tumores en humanos y en animales se basa en la actividad anticancerígena observada en experimentos in vitro e in vivo. El uso del ATP en la práctica clínica es discutido debido a resultados contradictorios. Por otra parte, no existen antecedentes del uso de ATP en el tratamiento de hepatocarcinomas. El objetivo del presente estudio fue determinar si el ATP previene la oncogénesis in vivo en un modelo de preneoplasia hepática murina de dos etapas. Para determinar la probable contribución de la adenosina, producto de la hidrólisis de ATP y descrita como tumorigénica, se estudió también el efecto del nucleósido exógeno sobre los focos preneoplásicos. Los animales se dividieron en grupos: ratas sometidas al modelo de preneoplasia de iniciación/promoción, ratas tratadas con ATP o adenosina intraperitonealmente durante las dos fases del modelo y los correspondientes grupos controles. El número y el volumen de focos preneoplásicos por hígado, identificados por la expresión de la forma placentaria de la glutation S- transferasa de rata y el número de células positivas para el antígeno nuclear proliferante, aumentaron significativamente en los grupos tratados con ATP y adenosina. Los resultados en su conjunto indican que en este modelo preneoplásico, el ATP y la adenosina alteran el balance entre apoptosis y proliferación, contribuyendo a la transformación maligna.

Omega-3 fatty acids reduce the development of preneoplasic lesions

Objective: The purpose of this study was to evaluate the anticancer potential of dietary omega-3 supplementation toreduce induced intestinal preneoplastic lesions in Wistar rats. Methods: A total of 58 11-week-old male Wistar rats (Rattus norvergicus, albinus variety, Rodentia) were distributed into two groups: a control group (n=25) and an omega-3-treated group (n=28). Aberrant crypt foci were induced by 1,2-dimethylhydrazine. Tissue incorporation of the supplemented omega-3 fatty acids was evaluated by determining the fatty acid profiles of intra-abdominal fat and the liver with gas chromatography.Results: The omega-3 group presented lower weight and lower food intake (p<0.05) than the control group. Thenumber of aberrant crypt foci decreased 55.34% in response to omega-3 supplementation. Foci with more than three crypts decreased 57.14% between weeks 13 and 28. There was no statistical difference for the docosahexaenoic acid content in the liver of the omega-3 group between week 6 and weeks 13 and 28. Conclusion: These results suggest that omega-3 may slow the progress of colorectal carcinogenesis.

Objetivo: O objetivo do estudo foi avaliar o potencial anticarcinogênico da suplementação com ômega-3 em reduzirlesões pré-neoplásicas induzidas em intestino de ratos Wistar. Métodos: Ratos Wistar machos, com 11 semanas de idade (Rattus norvergicus), foram subdivididos em dois grupos: grupo controle (n=25) e grupo ômega-3 (n=28). Os focus de criptas aberrantes foram induzidos pela 1,2 dimetilhidrazina. A incorporação dos ácidos graxos ômega-3 suplementados foi avaliada pela identificação do perfil de ácidos graxos da gordura intra-abdominal e do fígado por cromatografia gasosa. Resultados: O grupo ômega-3 apresentou menor consumo da dieta e menor ganho de peso (p<0,05) do que o grupo controle. O número de focus de criptas aberrantes foi reduzido em 55,34% como conseqüência da suplementação dietética com ômega-3. Os focus com três ou mais do que três criptas diminuíram 57,14% entre a 13ª a 28ª semanas. Não foi verificada diferença estatística para o conteúdo de ácido docosahexaenóico. Conclusão: O resultado sugere que o ômega-3 pode reduzir a evolução da carcinogênese colorretal.

Efficacy of 3% diclofenac gel for the treatment of actinic keratoses: a randomized, double-blind, placebo controlled study.

BACKGROUND: Actinic keratoses (AKs) are premalignant skin lesions caused by excessive sun exposure. AIMS: To explore the therapeutic efficacy of 3% diclofenac in 2.5% hyaluronan gel in the topical treatment of AK. METHODS: Sixty-four lesions in 20 patients were evaluated. They were randomized to receive either the active treatment, 3% diclofenac in 2.5% hyaluronan gel or placebo, which consisted of the inactive gel vehicle, hyaluronan for a period of three months. The collected data were analyzed by using Student t- tests. RESULTS: There was a reduction in the lesion size in 64.7% of diclofenac-treated lesions and 34.3% of control lesions during the three-month course of treatment. Only 9.3% of the lesions in the diclofenac group were completely cleared during three months of treatment. During the treatment, no significant side-effect was observed in both groups. CONCLUSION: Considering the malignant potential of actinic keratoses and the importance of clearing them to prevent their transformation to squamous cell carcinoma, the efficacy of diclofenac gel seen in our study seems to be low. This treatment may be useful for patients who do not tolerate other, more effective kinds of treatment for actinic keratoses.

Inhibitory effects of crude alpha-mangostin, a xanthone derivative, on two different categories of colon preneoplastic lesions induced by 1, 2-dimethylhydrazine in the rat.

The purpose of this study was to examine whether crude alpha-mangostin (a major xanthone derivative in mangosteen pericarp (Garcinia mangostana)) has short-term chemopreventive effects on putative preneoplastic lesions involved in rat colon carcinogenesis. The crude preparation was obtained by simple recrystallization of an ethylacetate extract of mangosteen pericarps. A total of 33 five-week-old male F344 rats were randomly divided into 5 experimental groups. Rats in groups 1-3 were given a subcutaneous injection of 1,2-dimethylhydrazine (DMH)(40 mg/kg body weight) once a week for 2 weeks. Starting one week before the first injection of DMH, rats in groups 2 and 3 were fed a diet containing 0.02% and 0.05% crude alpha-mangostin, respectively, for 5 weeks. Rats in group 4 also received the diet containing 0.05% crude alpha-mangostin, while rats in group 5 served as untreated controls. The experiment was terminated 5 weeks after the start. Dietary administration of crude alpha-mangostin at both doses significantly inhibited the induction and/or development of aberrant crypt foci (ACF) (P<0.05 for 0.02% crude alpha-mangostin, P<0.01 for 0.05% crude alpha-mangostin), when compared to the DMH-treated group (group 1). Moreover, treatment of rats with 0.05% crude alpha-mangostin significantly decreased dysplastic foci (DF) (P<0.05) and beta-catenin accumulated crypts (BCAC) (P<0.05), to below the group 1 values. The proliferating cell nuclear antigen (PCNA) labeling indices of colon epithelium and focal lesions in groups 2 and 3 were also significantly lower than in group 1 and this effect occurred in a dose dependent manner of the crude alpha-mangostin. This finding that crude alpha-mangostin has potent chemopreventive effects in our short-term colon carcinogenesis bioassay system suggests that longer exposure might result in suppression of tumor development.

Photodynamic therapy in management of head and neck cancers and precancerous lesions.

Photodynamic therapy (PDT) is a new form of cancer treatment with low morbidity. In this study, PDT was evaluated for its effectiveness in management of recurrent or widespread precancerous lesions, primary cancers in inoperable sites, recurrent or residual cancers which were refractory to radiotherapy and chemotherapy, and advanced tumors in the head and neck. Fifty-one patients were treated over a period of 5 years. A 91.67 per cent complete response rate was observed for T1 tumors (primary and recurrence) with a recurrent rate of 27.27 per cent. Nasopharyngeal carcinoma was highly responsive to PDT since all T1 and T2 tumors responded completely. This was in contrast to cancers in the soft palate which failed in most cases possibly due to inadequate light dose distribution. PDT was remarkably effective in curing premalignant diseases (100% complete response rate). Postoperative PDT was equally effective in treating the microscopic residual malignancy. For advanced tumors, PDT in adjunct to conventional modalities could induce complete response in 5 out of the 10 patients and resolve symptoms in 4 cases. The mean follow-up time for this series was 28.3 months (range 3-66 months). In conclusion, PDT is a useful modality for the treatment of head and neck tumors and precancerous lesions presenting in forms or under conditions that posed considerable difficulties in management by conventional approaches.

Prototipo de fuente lumínica pra terapia fotodinámica disenado en el Centro de Microscopía Electrónica / Prototype of light source for photodynmic therapy in Centre of Electron Mycroscopy

La Terapia Fotodinámica (PDT) es un tratamiento del cáncer basado en la acumulación específica de una droga fotosensible en el tejido maligno. Su posterior radiación con una longitud de onda apropiada, induce la producción de singuletes de oxígeno responsable de la peroxidación de las organelas y la muerte de las células neoplásicas. En el Centro de Microscopía Electrónica de la Universidad Nacional de Córdoba se diseñó y construyó un prototipo de fuente de irradiación no coherente de 630nm el que posibilitó la aplicación de PDT por primera vez en nuestro país. Este prototipo ha sido aplicado satisfactoriamente en el tratamiento de la queratosis actínica. Fueron tratadas 100 lesiones en 27 pacientes utilizando como fotosensibilizador al ácido d amino levulínico (ALA) al 20 por ciento La activación lumínica duró de 5 a 20 minutos dependiendo de la extensión y profundidad de la lesión. Los resultados obtenidos fueron los siguientes: Remisión Completa de las lesiones (RC) 84por ciento, Remisión parcial (RP) 10 por ciento, Sin respuesta (SR) 0 por ciento y Sin datos (SD) 6 por ciento. En el último grupo están incluidos aquellos pacientes que no retornaron para su evaluación. La alta efectividad, sumada a la inmejorable respuesta cosmética y la reducida agresividad, hacen de PDT el método de elección en el tratamiento de esta patología. El prototipo utilizado en este estudio demostró ser además de no invasivo y bien tolerado, altamente efectivo.

Desarrollo de los retinoides en investigación básica y clinica en oncología: conceptos actuales / The development of retinoids in basic research and clinics in oncology: current concepts

Después de mencionar brevemente algunos conceptos generales sobre el cáncer, se revisan los conceptos farmacológicos principales de los retinoides, (compuestos que comprenden a la vitamina A y a sus análogos naturales y sintéticos), así como los estudios epidemiológicos y mecanísmos de acción probables en cuanto al efecto anticancerígeno de estos compuestos. Después, se analiza la acción de ellos sobre neoplasias no cancerosas, enfermedades premalignas y cáncer de los aparatos digestivo, respiratorio, urinario, reproductor, locomotor y circulatorio, así como sobre el sistema nervioso central, órganos de los sentidos, tejidos blandos y, especialmente, de la piel y sus anexos. Se concluye que los retinoides han probado poseer acción contra las neoplasias malignas, probablemente por sus efectos sobre la proliferacción y diferenciacción celulares y que las indicaciones primordiales en ellos en el campo de la oncología las constituyen la prevención de neoplasias malignas en sujeitos de alto riesgo y el tratamiento de tumores malignos en fases iniciales (en combinacción con la modalidades terapéuticas clásicas y, sobre todo, cuando se descubre inmunosupresión), siendo el futuro muy promisorio en este aspecto de investigacción a la medicina