Fatores associados à sobrevida de pacientes com tumores de mediastino / Associated factors to survival of patients with mediastinal tumors

Os tumores de mediastino são patologias raras porém com uma taxa de letalidade elevada. Devido ao quadro clínico inespecífico, estudos que possam esclarecer quais são os fatores que estão associados a sobrevida, podem delinear estratégias de conduta que futuramente possam mudar esta situação. O objetivo do estudo foi determinar a sobrevida e os fatores associados em pacientes com tumores de mediastino na Grande Florianópolis. Foi realizado um estudo de análise de sobrevida no HRSJ em São José, SC. A população incluiu 127 pacientes com tumores de mediastino de junho de 1995 à dezembro de 2014. Os dados foram extraídos por uso do instrumento de coleta desenvolvido para o estudo. A análise estatística foi feita no programa SPSS® versão 16.0 e aplicaram-se o método Kaplan-Meier para as funções de sobrevida e o teste de Log-rank para associação. Aprovado no CEP UNISUL e HRSJ. A sobrevida geral em 5 anos foi de 77,5%. A proporção quanto ao gênero foi 1:1, com idade média de 44,31 anos. Nos tumores benignos 61,7% eram assintomáticos e os nos tumores malignos 63,4% eram sintomáticos (p=0,03). A sobrevida tumores de células germinativas foi de 30% em 5 anos e nos cistos foi de 100% em 5 anos. Os tumores malignos se mostraram os mais letais (p=0,02), sendo os tumores de células germinativas o principal tipo histológico. O quadro clínico sintomático mostrou-se mais prevalente nos tumores malignos.

Mediastinal tumors are a rare type of disease, however it has a high lethality rate. Owing to the inespecific clinical, studies that can elucidate which are the associated factors to survival, can trace strategies that in the future can change this situation. The objective of the study is to determine the survival and the associated factors in patients with mediastinal tumors at Florianópolis and São José. A survival analysis held at HRSJ in São José, SC. 127 patients were included diagnosed with mediastinal tumors from June 1995 to December 2014. Data were extracted by the use of the data collection instrument developed for the study. Statistical analysis was performed in SPSS® version 16.0 and have applied Kaplan-Meier method for the survival analysis and the Log-rank test for association. Approved in Ethical Committee in Research of UNISUL and HRSJ. The overall survival in 5 years was 77,5%. The gender proportion was similar, the mean age was 44,31 years. In benign tumors, 61,7% were assymptomatic and in malignant tumors, 63,4% were symptomatic (p=0,03). The survival of germ cells turmors were 30% in 5 years and in the cists were 100% in 5 years.The malignant tumors showed to be more lethal (p=0,02), as germ cells tumors the main histological type. The symptomatic clinical features were more prevalent in malignant tumors.

Fatores associados ao óbito intra-hospitalar em pacientes internados por infarto agudo do miocárdio / Factors associated with death intra-hospital in hospitalized patients for acute myocardial infarction

As doenças do aparelho circulatório são importantes causas de internação hospitalar. Dentre elas, o infarto agudo do miocárdio destaca-se pela sua morbimortalidade e seus custos gerados no Sistema Único de Saúde. Estudos que possam esclarecer quais são os fatores que estão associados a este desfecho podem delinear estratégias de conduta que futuramente possam mudar esta situação. O objetivo do estudo foi analisar os fatores associados ao óbito intra-hospitalar em pacientes internados por IAM no Instituto de Cardiologia de Santa Catarina (ICSC). Estudo de coorte não-concorrente realizado no ICSC em São José, SC. A população incluiu 349 pacientes internados com diagnóstico de IAM no período de janeiro de 2013 à janeiro de 2014. Os dados foram extraídos por meio do uso do instrumento de coleta de dados desenvolvido para o estudo. A análise estatística foi feita no programa Stata® versão 10 e aplicaram-se os testes do qui-quadrado ou exato de Fisher, com p<0,05. O risco relativo foi estimado com intervalo de confiança de 95%. Aprovado no CEP UNISUL e ICSC. Dos 349 pacientes incluídos no estudo, 4,58% foram a óbito. A maioria da população era do sexo masculino (67,62%) com idade entre 51-70 anos. As variáveis com significância estatística foram: acometimento de TCE (p=0,001), classificação de Killip (p=0,001), PCR (p=0,001), diabetes (p=0,01). Os fatores associados ao óbito intra-hospitalar em pacientes internados por IAM foram: acometimento de TCE, classificação de Killip, PCR nas primeiras 48 horas com sucesso na reanimação, tempo de internação e diabetes.

Cardiovascular diseases are major causes of hospitalization. Among them, acute myocardial infarction (AMI) is distinguished by its morbidity and costs generated in the Health System. Studies that can clarify what are the factors that are associated with this outcome can devise management strategies that may eventually change this situation. The objective of this study is to analyze the factors associated with in-hospital death risk in patients hospitalized with AMI in Instituto de Cardiologia de Santa Catarina (ICSC). A retrospective cohort study was conducted in ICSC in São José, SC. The population included 349 patients hospitalized with AMI between January 2013 and January 2014. Data were extracted by the use of the data collection instrument developed for the study. Statistical analysis was performed in Stata® version 10 and have applied the chi-square or Fisher exact test, with p <0.05. The relative risk was estimated with a confidence interval of 95%. Approved in Ethical Committee in Research of UNISUL and ICSC. Of the 349 patients included in the study, 4.58% died. The majority of the population was male (67,62%) aged 51-70 years. The statistically significant variables were: impairment of the left main coronary artery (p=0,001), Killip classification (p= 0,001), cardiac arrest (p<0,001), diabetes (p=0,01). The factors associated with in-hospital death in patients hospitalized for AMI were: involvement of the left main coronary artery, Killip classification, cardiac arrest within 48 hours with successful resuscitation, hospitalization time and diabetes.

Análise da eficácia do ácido zoledrônico no tratamento adjuvante do câncer de mama quanto a mortalidade e recidiva / Examine the effectiveness of zoledronic acid in the adjuvant treatment of breast cancer in terms of mortality and recurrence

Objetivo: realizar uma revisão da literatura para analisar a eficácia do ácido zoledrônico(ZOL) no tratamento adjuvantedo câncer de mama quanto à mortalidade e recidiva. Método: para a realização da busca, foi utilizada a base de dadosMedline, usando os descritores ?zoledronic acid OR Diphosphonates? ?AND Breast Neoplasms? e o filtro ?TherapyBroad?. Os critérios de inclusão e exclusão pré-estabelecidos foram utilizados para selecionar os estudos incluídosnesta revisão. Resultados: Foram incluídos quatro estudos. O ABCSG-12 observou uma redução dos eventos desobrevida livre de doença (p=0,008) e do número de mortes (p=0,09) no grupo com ZOL. Já no estudo AZURE, asobrevida livre de doença (p= 0,79) e o número de mortes (p=0,07) não apresentaram diferença significativa entreos grupos na população geral, sendo observado benefício somente nas pacientes com menopausa há mais de cincoanos, com diferença na sobrevida global significativa (p= 0,04). Coleman et al, em 2010 verificou maior redução dotamanho do tumor invasivo residual no grupo que recebeu ZOL (p=0,0059). O ZO-FAST demonstrou uma diferençaabsoluta na sobrevida livre de doença de 3,2% (p= 0,0314) a favor do grupo que recebeu ZOL imediato. Conclusão:Não se pode afirmar que o ácido zoledrônico seja benéfico na terapia adjuvante do câncer de mama para todas asmulheres, porém os resultados são promissores quando utilizado em pacientes com baixos níveis estrogênico.

Objective:It is a literature review to examine the effectiveness of zoledronic acid (ZOL) in the adjuvant treatmentof breast cancer in terms of mortality and recurrence. Method:It was used the Medline database, using the keywords?Diphosphonates OR zoledronic acid??AND Breast Neoplasms? and the filter ?Therapy Broad?. The inclusion andexclusion criteria previously established were used to select the studies included in this review. Results: Four studieswere included. The ABCSG-12 observed a reduction in the event-free survival (p = 0.008) and in the number ofdeaths (p = 0.09) in the group with ZOL. In the AZURE trial, the disease-free survival (p = 0.79) and the numberof deaths (p = 0.07) did not show significant difference between groups in the general population. The benefit wasobserved only in patients with menopause for more than five years, with significant difference in overall survival (p =0.04). Coleman et al, in 2010, found a further reduction in tumor size invasive residual in the group receiving ZOL (p= 0.0059). The ZO-FAST demonstrated an absolute difference in disease-free survival of 3.2% (p = 0.0314) in favorof the group receiving ZOL immediately. Conclusion:It is not possible to assert that zoledronic acid is beneficial inthe adjuvant therapy of breast cancer for all women; however, the results are promising when used in patients withlow estrogen levels.

Effects of perioperative hypothermia and reactive oxygen species in the healing of colonic anastomosis in rats

PURPOSE: We evaluated the hypothesis that induced perioperative hypothermia (32 ± 1ºC) affects the redox balance in the tissue of colonic anastomosis in rats by modifying biochemical enzymatic and non-enzymatic markers related to oxidative stress. METHODS: Forty-eight male Wistar rats were randomly divided into eight experimental groups of six animals each and underwent laparotomy, sigmoid section and immediate anastomosis. Four groups were operated under normothermia (36 ± 1ºC), and the other four under hypothermia (32 ± 1ºC). The animals were reoperated on days 3, 7 and 14 postoperatively, and two groups underwent SHAM at 3 days. From the scar tissue samples, the activity of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) was evaluated, and the levels of non-enzymatic markers of oxidative stress, such as reduced glutathione (GSH) and lipid peroxidation, were measured by the thiobarbituric acid reactive substances (TBARS) assay. The means were compared between groups corresponding to each day of sampling and euthanasia. RESULTS: The hypothermic groups showed a significant reduction on the activity of SOD on day 7 postoperatively, on the activity of CAT on days 7 and 14 postoperatively and on the levels of GSH on day 7 postoperatively. The level of lipid peroxidation was increased in the hypothermia group on day 7 postoperatively and decreased on day 14 compared with the normothermic groups. CONCLUSION: Perioperative hypothermia reduced the activity of the antioxidant enzymes catalase and superoxide dismutase, glutathione levels and increased lipid peroxidation in the scar tissue of colonic anastomoses in rats. .