Adherence to treatment guidelines for primary sarcomas affects patient survival: a side study of the European CONnective TIssue CAncer NETwork (CONTICANET).

BACKGROUND: The impact of adherence to clinical practice guidelines (CPGs) for loco-regional treatment (i.e. surgery and radiotherapy) and chemotherapy on local disease control and survival in sarcoma patients was investigated in a European study conducted in an Italian region (Veneto). PATIENTS AND METHODS: The completeness of the adherence to the Italian CPGs for sarcomas treatment was assessed by comparing the patient's charts and the CPGs. Propensity score-adjusted multivariate survival analysis was used to assess the impact of CPGs adherence on patient clinical outcomes. RESULTS: A total of 151 patients were included. Adherence to CPGs for loco-regional therapy and chemotherapy was observed in 106 out of 147 (70.2%) and 129 out of 139 (85.4%) patients, respectively. Non-adherence to CPGs for loco-regional treatment was independently associated with AJCC stage III disease [odds ratio (OR) 1.77, P = 0.011] and tumor-positive excision margin (OR 3.55, P = 0.003). Patients not treated according to the CPGs were at a higher risk of local recurrence [hazard ratio (HR) 5.4, P < 0.001] and had a shorter sarcoma-specific survival (HR 4.05, P < 0.001), independently of tumor stage. CONCLUSIONS: Incomplete adherence to CPGs for loco-regional treatment of sarcomas was associated with worse prognosis in patients with non-metastatic tumors.

Avaliação da atividade antioxidante do extrato aquoso de Lafoensia pacari A. ST-HIL. em emulsão não-iônica / Evaluation of antioxidant activity of aqueous extract of Lafoensia pacari A. ST.-HIL. in non-ionic emulsion

O envelhecimento cutâneo está relacionado com a ação de radicais livres que, por consequência da senescência, acabam estando em maior quantidade e logo as defesas naturais não conseguem eliminá-los. O objetivo deste trabalho foi desenvolver uma emulsão não-iônica com adição do extrato aquoso das entrecascas de Lafoensia pacari A. St.-Hil. e avaliar sua estabilidade físico-química, assim como a atividade antioxidante. O extrato aquoso foi preparado sob refluxo na proporção 1:25. A dosagem de polifenóis totais se deu pelo método Folin-Ciocalteau, com ácido tânico como padrão. Foram incorporados à emulsão não-iônica BHT e ácido ascórbico, ambos empregados como substâncias de referência e o extrato aquoso na concentração de 1%. A análise da atividade antioxidante foi realizada pelo método do fosfomolibdênio, onde cada amostra foi diluída a concentração de 400 miug/mL. A incorporação de extrato aquoso de L. pacari não influenciou de maneira significativa na estabilidade do creme em relação ao tempo de análise. A quantificação de polifenóis mostrou que a extração aquosa à quente não foi um método eficiente, resultando em um EAT (equivalente de ácido tânico) de 1,0328 mg/mL. Proporcional à concentração de polifenóis, a atividade antioxidante foi baixa, não ultrapassando 5,0% de atividade em relação ao ácido ascórbico.

Cutaneous aging is related to the action of free radicals, which appear in greater quantity as a consequence of senescence, so that natural defenses cannot eliminate them. The aim of this study was to develop a non-ionic emulsion containing an aqueous extract of the inner bark of Lafoensia pacari A. St.-Hil. and assess its physicochemical stability, as well as its antioxidant activity. The aqueous extract was prepared under reflux with a 1:25 ratio of bark:distilled water (w/v). The total polyphenol content was determined by the Folin-Ciocalteau method, with tannic acid as standard. BHT, ascorbic acid and the aqueous extract were incorporated into the non-ionic emulsion, each of them at a concentration of 1%, the first two being. used as reference substances. Antioxidant activity was analyzed by the phosphomolybdenum method, each emulsion being first diluted in water to 400 ìg / mL. The addition of aqueous extract of L. pacari did not significantly affect the stability of the cream over the period of analysis. The content of polyphenols showed that hot aqueous extraction was not an efficient method, resulting in a tannic acid equivalent (TAE) of 1.0328 mg/mL in the crude extract. Proportional to the polyphenol concentration, the antioxidant activity was also low, not exceeding 5.0% of the activity of the ascorbic acid.

Mammography findings following electron intraoperative radiotherapy or external radiotherapy for breast cancer treatment.

Radiotherapy following breast cancer conserving surgery decreases the risks of local recurrence. Because 85% of breast cancers relapse in or around the surgical bed there has been some debate on the need for irradiating the whole breast. Electron intraoperative radiotherapy (ELIOT) has been used as a viable alternative for conventional external radiotherapy (RT). While the former requires a single dose of 21 Gy in the tumoral bed, the latter requires 5-6 weeks of irradiation with a total dose of 50 Gy and a boost of 10 Gy that irradiates the surgical bed. Herein, we investigated whether any significant differences exist between the mammography findings obtained from patients submitted to one of the two techniques. Two groups of 30 patients each were included in this study. All patients had mammographies taken at 12 and 24 months after finishing treatment. The mammography findings evaluated were: cutaneous thickening (>2mm), architectural distortion secondary to fibrosis, edema, calcifications (both benign and malignant), and fat necrosis. For all variables studied, there was no statistical difference between the two groups. This indicates that the mammography findings obtained in either 12- or 24-month follow-up periods after breast cancer conserving surgery are similar, regardless of which of the two radiotherapy techniques (ELIOT or RT) is employed as a treatment for breast cancer.

Potentially pathogenic Acanthamoeba in swimming pools: a survey in the southern Brazilian city of Porto Alegre.

Between May 2006 and March 2007, 65 water samples were collected from both heated and unheated swimming pools in the city of Porto Alegre, the capital of the Brazilian state of Rio Grande do Sul. The aim was to explore the problem posed by, and the pathogenic potential of, Acanthamoeba in the pools. Free-living amoebae in the samples were isolated by culture with Escherichia coli and identified from trophozoite and cyst morphology and the results of a PCR with Acanthamoeba-specific oligonucleotide primers. Potential pathogenicity was assessed in osmotolerance and thermotolerance assays. Thirteen (20%) of the water samples investigated were found positive for free-living amoebae, all identified as belonging to morphological groups II (nine isolates) or III (four isolates) of the genus Acanthamoeba. All 13 isolates were found positive in the Acanthamoeba-specific PCR, and the results of the tolerance assays indicated that five (38%) of the isolates should be considered potentially pathogenic. The results of this first study on the occurrence and distribution of Acanthamoeba in the water of swimming pools in Porto Alegre confirm the presence of potentially pathogenic types that may present a risk to human health.

Análise da qualidade de cremes com hidroquinona 2% manipulados no município de Ijuí/RS / Quality analysis of creams with 2% hydroquinone prepared in pharmacies in the town of Ijuí (RS, Brazil)

A hidroquinona é o agente despigmentante maisutilizado para o tratamento de hiperpigmentações cutâneas. Entretanto, esta substância sofre oxidação facilmente quando em presença de luz, umidade e ar, sendo necessário o uso de agente antioxidante para proteger a formulação. Avaliou-se a qualidade de cinco amostras adquiridas em farmácias de manipulação do município de Ijuí/RS, com o objetivo de observar o uso de antioxidantes, a escolha da base e da embalagem, avaliando-as logo após sua manipulação e ao término do seu prazo de validade. O doseamento do teor de hidroquinona foi realizado através do método de titulação volumétrica por óxido-redução. Todas as amostras foram envasadas em bisnagas metálicas, entretanto, nem todas continham antioxidantes. Após análise dos resultados concluiu-se que o creme em base aniônica contendo BHT 0,02% e bissulfito de sódio 0,25% apresentou-se mais estável, após sua manipulação com teor de 103,37% e assim como ao término do seu prazo de validade com 96,94%, sem alteração de cor e com aspecto agradável.

Intraoperative radiotherapy in the conventional linear accelerator room for early breast cancer treatment: an alternative choice in developing countries.

Intraoperative radiotherapy with a single dose of electrons (ELIOT) in the conservative treatment of breast cancer is a possibility under evaluation in clinical trials. The costs of the mobile linear accelerator with a robotic arm, used in intraoperative radiotherapy, are prohibitive for poor countries. The aim of this study was to evaluate the feasibility of ELIOT in the accelerator room of the Radiotherapy Service for early breast cancer treatment. We analyzed 40 patients submitted to breast conservative surgery and ELIOT, in the accelerator room of the Radiotherapy Service at the Hospital of Pontificia Universidade Católica do Rio Grande do Sul in Brazil from January 2004 to July 2005. Patients with unifocal breast carcinoma smaller than 25 mm, aged over 45 years, who were candidates for conservative surgery were selected and a total dose of 21Gy was delivered, without further radiotherapy. In the short-term follow-up (median 18 months), six patients (15%) presented with some grade of fibrosis under the scar. One case (2.5%) of local recurrence was reported. There are no cases of contralateral carcinoma or distant metastases so far. Our data show that intraoperative radiotherapy with electrons can be safely performed in an accelerator room with a conventional machine.

SOPRoxi: a research-intervention project for suicide survivors.

In Italy, postvention models specifically designed for people surviving the suicide of a loved one are very scarce. The SOPRoxi project was developed to respond to this particular lack. By involving different professional and nonprofessional figures (GPs, mental health professionals, social workers, volunteers, etc), the SOPRoxi project aims to remove the stigma associated with this condition and to offer adequate, multifaceted help to survivors.

Optimised nuclear medicine method for tumour marking and sentinel node detection in occult primary breast lesions.

The aim of this study was to evaluate the feasibility of sentinel node (SN) biopsy in occult breast lesions with different radiopharmaceuticals and to establish the optimal lymphoscintigraphic method to detect both occult lesions and SNs (SNOLL: sentinel node and occult lesion localisation). Two hundred and twenty-seven consecutive patients suspected to have clinically occult breast carcinoma were enrolled in the study. In addition to the radioguided occult lesion localisation (ROLL) procedure, using macroaggregates of technetium-99m labelled human serum albumin (MAA) injected directly into the lesion, lymphoscintigraphy was performed with nanocolloids (NC) injected in a peritumoral (group I) or a subdermal site (group II). In group III, a sole injection of NC was done into the lesion in order to perform both ROLL and SNOLL. Overall, axillary SNs were identified in 205 of the 227 patients (90.3%). In 12/62 (19.4%) patients of group I and 9/79 (11.4%) patients of group III, radioactive nodes were not visualised, whereas SNs were successfully localised in 85 of 86 patients of group II ( P<0.001). Pathological findings revealed breast carcinoma in 148/227 patients (65.2%) and benign lesions in 79 (34.8%). A total of 131 axillary SNs were removed in 118 patients with breast carcinoma; intraoperative examination of the SNs revealed metastatic involvement in 16 out of 96 cases of invasive carcinoma (16.7%). It is concluded that the combination of the ROLL procedure with direct injection of MAA into the lesion and lymphoscintigraphy performed with subdermal injection of radiocolloids represents the method of choice for accurate localisation of both non-palpable lesions and SNs.

Paraneoplastic neurological disorders in breast cancer.

Paraneoplastic syndromes are the rarest neurological complications in patients with cancer. The neurological paraneoplastic syndromes that are mainly associated with breast cancer are subacute cerebellar degeneration, paraneoplastic retinopathy, opsoclonus-myoclonus syndrome, lower motor neuron diseases and Stiff-man syndrome. The aim of this paper is to briefly outline these paraneoplastic neurological syndromes and consider their relation to breast carcinoma.

Caracterização físico-química e biológica do caule de Caesalpinia ferrea Mart. / Physico-chemical and biological characterization of Caesalpinia ferrea Mart. stems

Visando estabelecer parâmetros para o controle da qualidade do caule de Caesalpinia ferrea Mart. (Caesalpiniaceae), foram realizados testes preconizados pela Farmacopéia Brasileira IV e pela Organização Mundial da Saúde para a avaliação da pureza, através das determinações de materiais estranhos, cinzas totais, cinzas insolúveis em ácido, umidade, ensaios-limites de cloretos e sulfatos, além da pesquisa de contaminantes microbianos no material pulverizado. Para a caracterização dos constituintes, eventualmente presentes na droga vegetal, foram realizadas as determinações de taninos, dos índices de espuma, intumescimento e amargor e o teste de hemólise; também foi realizada a caracterização do extrato etanólico bruto e suas frações por cromatografia em camada delgada.

In order to establish parameters for the control quality of Caesalpinia ferrea Mart. stem, the drug was characterized by the methods described in Farmacopéia Brasileira IV and by the World Health Organization. The powdered plant material was submitted to the following tests for purity evaluation: foreign matter, total ash, acid insoluble ash, water content, chloride and sulfate limit assays, and microbiological contamination. Determination of haemolytic activity, foaming index, swelling index and bitterness index were done to characterize the constituents eventually present in the drug, as well as the characterization of the ethanolic crude extract and its fractions by thin-layer chromatography.

Identification of sentinel node in breast cancer.

Axillary lymphadenectomy is a very important procedure in the staging of breast cancer patients. However, it is associated with a significant morbidity rate. On the other hand, using early diagnosis we can see a high number of cases where the lymph nodes are negatives. With the intention of avoiding unnecessary axillary dissection, the possibility of evaluating a single node has been studied. This lymph node, defined as "sentinel node", would be the first to receive tumoral lymphatic drainage. The aim of this study is to evaluate: (i) the efficacy of the methods to identify the sentinel nodes, (ii) estimate the predictability of the histological examination of the sentinel node in comparison to other nodes of the axilla, (iii) compare the efficacy of the frozen section regarding the definitive histological examination of the same node. This study was performed in 29 patients, and the sentinel node was identified in all of them. It was metastatic in 7 (24.1%). Out of the 22 patients where the node was negative, 15 were submitted to complete dissection. Out of these 15, there was one case (6.7%) where one lymph node of the first level was positive. All 7 patients with the positive sentinel node were submitted to axillary dissection. When comparing the histological examination of the sentinel node with other nodes, we got a sensitivity of 87.5%, specificity of 100%, predictive positive value of 100%, predictive negative value of 93% and efficacy of 95%. The intra-operative examination was made in 24/29 cases (82.7%). The correlation between both examinations was 95.8%. This study shows that the technique of the sentinel node will be a reliable method to avoid radical axillary dissection in breast cancer patients with early diagnosis.

Estadiamento cirúrgico no câncer do ovário / Surgical staging in ovarian neoplasms

Junto ao "Istituto Nazionale per lo studio e la cura dei Tumori di Milano", no período de 1975 a 1985, 201 pacientes acometidas de carcinoma do ovário, näo tratadas anteriormente com quimioterapia ou radioterapia, foram submetidas a estadiamento cirúrgico completo para estabelecer a difusäo da doença e planificar o tratamento. O estadiamento cirúrgico compreende: coleta de líquido peritoneal, líquido de ascite ou lavado peritoneal, histerectomia total com anexectomia bilateral, omentectomia, apendicectomia, dissecçäo linfonodal ilíaca e lombo-aórtica e biópsias múltiplas. Em 153 pacientes foi efetuado pré-operatoriamente estadiamento clínico/instrumental compreendendo laparoscopia com inspeçäo diafragmática, biópsias múltiplas e lavado peritoneal, linfografia, enema opaco e urografia. Nestes casos uma estadiaçäo clínica insuficiente comparada com o estadiamento cirúrgico foi observada em 41,9% no estádio I, 44,4% no estádio II e em 7,9% no estágio III. A sensibilidade da linfografia e da laparoscopia relacionada com os achados anátomo-cirúrgicos foi respectivamente de 79,6% e 49,6%. O estadiamento cirúrgico permitiu conhecer melhor a modalidade de difusäo do carcinoma ovariano e em particular esclareceu a entidade da metastatizaçäo linfonodal em uma neoplasia considerada quase exclusivamente de difusäo peritoneal. Metástases linfonodais estavam presentes em 16,3% no estádio I, 18,1% no estádio II, 58,8% no estádio III e 46,1% no estádio IV. Os dados aparesentados confirmam que o estadiamento anátomo-cirúrgico é o único procedimento correto para estabelecer a difusäo da neoplasia em fase aparentemente localizada

Fenretinide: prevençäo em pacientes tratados de carinoma de mama / Fenretinide: prevention in patients treated of breast carcinoma

A Fenretinide (HPR) é um retinóide sintético análogo à Vit. A que provou ser efetivo na prevençäo de tumores mamários em animais modelos. Este estudo, nesta fase I, foi proposto no Instituto Nacional dos Tumores de Miläo com o objetivo de avaliar a tolerância desta droga em humanos. Neste estudo, 101 pacientes com câncer de mama foram randomizadas em 4 grupos de acordo com a dose diária da droga: 100mg, 200mg, 300mg e placebo. Todas as pacientes foram operadas no mesmo Instituto e näo receberam nenhum tratamento adjuvante (endócrino ou quimioterápico). Exame clínico, testes sangüíneos de laboratório, avaliaçäo dermatológica e oftalmológica foram realizadas periodicamente. Uma paciente interrompeu o tratamento na 12ª semana, por terem sido demonstradas metástases ósseas e pulmonares. Cem pacientes completaram as 20 semanas de tratamento e näo apresentaram efeitos colaterais significativos. Em um caso foi necessário diminuir a dose por três dias com o objetivo de verificar a possível correlaçäo entre linfagite recorrente e o tratamento com HPR. A paciente tornou a utilizar a dose de 200mg/dia e os sintomas desapareceram independentemente. Uma cuidadosa avaliaçäo dos efeitos da droga sobre o ciclo menstrual demonstrou que as irregularidades observadas eram relacionadas muito mais com a idade da paciente do que com o uso da droga. Depressäo e labilidade emocional foram observadas em 18 casos. Todavia estes sintomas estavam presentes desde a semana zero e näo aumentaram de intensidade durante o tratamento. Durante as 20 semanas do estudo nenhum carcinoma na mama contralateral foi observado