Mitomycin-C- or cisplatin-based chemoradiotherapy for anal canal carcinoma: long-term results.

PURPOSE: To evaluate the long-term efficacy of concurrent radiotherapy with mitomycin-C (MMC)-based or cisplatin (CP)-based combinations in a cohort of patients with locally advanced anal canal carcinoma. METHODS AND MATERIALS: Between 1988 and 2000, 179 patients with locally advanced anal canal carcinoma were treated at the Instituto Nacional de Câncer with two cycles of chemotherapy during Weeks 1 and 5 of radiotherapy. 5-Fluorouracil (750 mg/m(2) 120-hour infusion or 1,000 mg/m(2) 96-hour infusion) plus CP (100 mg/m(2)) on the first day of each cycle or MMC (10-15 mg/m(2)) on the first day of Cycle 1 was administered concurrent with radiotherapy (total dose, 55-59.4 Gy). Of the 179 patients, 60% were included from a randomized trial initiated at the Instituto Nacional de Câncer in 1991 that compared concurrent chemoradiotherapy with MMC vs. CP. RESULTS: The median follow-up for the whole chemoradiotherapy group was 83 months. The median patient age was 58 years, 57% had Stage T3-T4 tumors, and 35% had N-positive disease. The 5-year cumulative colostomy rate was not significantly different between the CP group (22%) and MMC group (29%; p = .28). The actuarial 10-year overall survival and disease-free survival rate for the CP group was 54% and 49% and for the MMC group was 52% and 53%, respectively (p = .32 and p = .92, respectively). On multivariate analysis, male gender (p = .042) and advanced Stage T3-T4 disease (p <.0001) were statistically significant for worse disease-free survival. Stage T3-T4 (p = .039) and N+ (p = .039) disease remained independently significant for overall survival. CONCLUSION: Long-term follow-up has confirmed the good results of chemoradiotherapy with CP plus 5-fluorouracil, which seem to provide results equivalent to those with MMC plus 5-fluorouracil.

Third eyelid gland protrusion in dogs: an experimental model proposal / Protrusão da glândula da terceira pálpebra em cães: proposta de um modelo experimental

The objective of this research was to present an experimental model for the prolapse of the third eyelid gland in male, adult mongrel dogs by the use of a periorbital glandular support conjunctiva tissue resection followed by macro and microscopic assessments. Length, thickness and width of normal glands were statistically studied at baseline and then again after a period of 30 days of exposition. In relation to the experimental model, 84.21 percent of glands, which underwent the resection of the conjunctiva support tissue, support tissue, remained protusioned. There were significant differences between normal and protusioned glands. Protusioned glands were larger in respect to length, thickness and width. For the microscopy studies, two experimental groups were established: non-treated protusioned glands (GI); and buried protusioned glands (GII). Glandular, conjunctiva tissue, and duct alterations were studied in both groups. Through the results obtained by the Schirmer's test, it was evidenced that the lachrymal production decreased when compared to the normal ones not protusioned, especially in those cases where the protusioned glands were not buried.

Neste trabalho, propõe-se um modelo experimental de protrusão da glândula da terceira pálpebra em cães mestiços, machos adultos e valendo-se da ressecção do retináculo glandular periorbitário e de avaliações macro e microscópicas. Foram estudadas, a estatística, o comprimento, a espessura e a largura de glândulas normais e após um período de 30 dias de exposição. Relativamente ao modelo experimental, 84,2 por cento das glândulas em que foi realizada a ressecção do retináculo permaneceram protruídas. Houve diferença significativa entre as glândulas normais e as protruídas. As glândulas protruídas aparentaram-se maiores quanto ao comprimento, à espessura e à largura. Para estudos à microscopia, constituíram-se dois grupos experimentais: glândulas protruídas não-tratadas (GI) e glândulas protruídas sepultadas (GII). Estudaram-se as alterações ductais, as glandulares e as conjuntivais em ambos os grupos. Os resultados mostraram que glândulas protruídas não-tratadas apresentaram maior porcentagem de alterações inflamatórias, glandulares e ductais. Mediante análise do teste de Schirmer I, constatou-se que a produção lacrimal diminuiu, quando comparada às glândulas normais não-prolapsadas, notadamente nos casos em que as glândulas prolapsadas não foram sepultadas.

Canine lacrimal and third eyelid superficial glands' macroscopic and morphometric characteristics

As glândulas lacrimal e superficial da terceira pálpebra atuam produzindo o componente aquoso do filme lacrimal. Nesta pesquisa, estudaram-se aspectos morfológicos e morfométricos do parênquima e do estroma de ambas as glândulas em cães mestiços, hígidos, adultos (machos ou fêmeas). As glândulas lacrimal e superficial da terceira pálpebra de 14 cães foram colhidas, totalizando 56 amostras. Foram estudadas, à estatística, as variáveis macroscópicas e morfométricas, comparando-as quanto ao tipo glandular (lacrimal e superficial da terceira pálpebra) e quanto ao dimorfismo sexual (macho e fêmea). As glândulas lacrimais foram significativamente maiores comparativamente as superficiais da terceira pálpebra. Foram evidenciados diferenças morfométricas expressivas quanto aos vasos e ductos interlobulares, ducto interlobular, infiltração linfocitária e parênquima secretório entre os dois tipos glandulares. As glândulas lacrimais dos machos foram significativamente maiores comparativamente às fêmeas, assim como as glândulas superficiais da terceira pálpebra apresentaram-se mais espessas. A maior infiltração linfocitária e a menor proporção de parênquima secretor nas fêmeas poderá ser uma das razões para uma maior incidência de ceratoconjuntivite seca (CCS) em fêmeas na população canina.

Use of topical mitomycin C in myoplasty of the medial rectus muscle of rabbits.

To possibly reduce postoperative adhesions that occur after ocular myoplasties, we investigated the topical effects of 0.04% mitomycin C on the repaired areas of the medial rectus muscle using an equine renal capsule preserved in 98% glycerin for reinforcement of the sutures. Twenty-four rabbits, divided into two groups of 12 animals each [untreated (control) and treated group (MMC)], were submitted to surgical rupture of the medial rectus muscle of one eye and repair of the defect 24 h later with sutures and an equine renal capsule. Post-operative prophylactic treatment of the two groups consisted of the administration of eye drops containing neomycin, polymyxin B and dexamethasone at regular 6-h intervals for eight consecutive days and daily rinsing with physiological saline. MMC animals received additional treatment with topical 0.04% mitomycin C every 6 h for 14 consecutive days. Slit lamp biomicroscopy showed greater irritation of the ocular surface in MMC animals during the first days post operatively. Adhesions were observed at 15 and 30 days of assessment in the two groups, but were more extensive in control animals at 60 days. Histopathology revealed inflammatory exudation in both groups, which was greater in MMC animals. Mitomycin C (0.04%) instilled at 6-h intervals for 14 consecutive days reduced the occurrence of fibrosis in the myoplastic areas. However, the equine renal capsule was found to be of little benefit for the reinforcement of myoplasties.

Uveodermatologic syndrome in a Brazilian Fila dog.

A 5-year-old Brazilian Fila dog was presented with a history of vision loss, alopecia, and generalized depigmentation of the skin and hair. Clinical examination confirmed generalized depigmentation and pyodermitis. On ophthalmic examination there was depigmentation at the eyelid mucocutaneous junction, associated with anterior uveitis, and bilateral posterior synechia at 360 degrees. Both the complete blood count and skin scraping were normal. Skin biopsy showed histiocytary lichenoid interface dermatitis with an absence of pigment within the queratinocytes, and a moderate lymphomononuclear infiltrate and predominance of histiocytes in the papilar derma suggestive of uveodermatologic syndrome. Clinical management consisted of oral and topical administration of prednisone, associated with 1% indometacine eye drops. Methylprednisone was also used twice via the subconjunctival route, at an interval of 15 days. To prevent the development of secondary glaucoma due to posterior synechiae, dorzolamide and timolol eye drops were indicated. Both dermatologic and ophthalmic signs showed good improvement, vision was preserved, and some repigmentation of the skin and hair occurred.

Alternância intensiva de drogas sem resistência cruzada presumível com methotrexate, adriamicina, ciclofosfamida, vincristina e fluorouracil (MACOM-F) no câncer da mama avançado locorregional / A

E apresentada uma nova estratégia de tratamento do câncer de mama avançado locorregional, fundamentada no uso de drogas sem resistência cruzada pressumível ou toxidade cumulativa, em 12 ciclos semanais. A finalidade foi a de obter citorreduçäo rápida, visando a operabilidade e tratamento das micrometástases. As drogas empregadas foram a ciclofosfamida 300 mg/m e adriamicina 50 mg/m nas semanas 1, 3, 5, 7, 9 e 11; methotrexate 100mg/m e, 24 horas após, resgate pelo leucovorin 15 mg/m de 6/6 horas, por oito vezes, nas semanas 2, 4, 6, 8, 10 e 12; fluouroracil 600 mg/m nas semanas 2, 6 e 10 e vincristina 1,4 mg/m (máximo 2 mg) nas semanas 4, 8 e 12 (MACOM-F). Neste estudo fase II foram incluidas 24 pacientes considerados avaliáveis e em bom estado geral (PS 0 e 2). Dessas 24 pacientes, 22 (91 porcento) obtiveram respostas positivas, sendo nove 937 porcento) resposta completa (RC), 13 (54 porcento) resposta parcial maior do que 50 porcento (RP) e duas (9 porcento) com doença estável (DE), reduçäo do tumor menor do que 50 porcento. A toxidade foi considerada aceitável e 18 foram submetidas a mastectomia radical. Decorridos 53 meses do ínicio do protocolo, das 18 operadas, sete recidivaram e cinco faleceram. Neste período de 34 semanas de seguimento médio, 59 porcento estäo vivas e 44 porcento sem evidência de doença. Os objetivos deste estudo foram: 1) testar o fundamento da teoria de Goldie-Coldman no tratamento de câncer de mama avançado locorregional; 2) verificar a eficácia e toxidade da administraçäo sequêncial intensiva das drogas mais ativas na atualidade para o câncer de mama; 3) determinar a açäo do MACOM-F, seguido de cirurgia, na qualidade e aumento do intervalo livre da doença (ILD) e sobrevida (SV) dessas doentes. O MACOM-F foi muito eficaz como tratamento neoadjuvante desses casos de câncer de mama avançado locorregional, podendo se tornar a primeira opçäo nessas circunstâncias. Todavia, é necessário maior número de doentes tratados para sua definitiva recomendaçäo.