Distal resection margins in rectal cancer specimens: differences in assessment between surgeons and pathologists and the influence of neoadjuvant chemoradiation.

To investigate the discrepancy between the distal resection margin (DRM) assessed by surgeons and pathologists, and the impact of neoadjuvant chemoradiotherapy (nCRT) on DRM. This study included 67 rectal cancer patients undergoing elective surgery. DRMs were assessed through four different techniques: in vivo subjective estimative, made by the surgeon before the rectal resection (by palpation and visual estimative); in vivo objective, measured with a ruler before the rectal transection; ex vivo objective, measured right after resection of the specimen; post-fixation objective measurement, conducted by the pathologist. The DRMs subjectively and objectively assessed by the surgeons were not significantly different (3.40 cm vs. 3.45 cm). There was a mean reduction in the length of DRMs of 35.6%, from 3.45 cm objectively measured by the surgeon to 2.20 cm measured by the pathologist. This difference was significant among patients that did not receive nCRT (3.90 cm vs. 2.30 cm, P < 0.001), but not among those who received nCRT (2.30 vs. 2.05 cm). Surgeons are accurate in assessing rectal cancer DRMs. There are significant differences between intraoperative measurements of DRMs and the final pathologic results. However, these differences are not seen when nCRT is used, a finding that may be useful when sphincter preservation is being considered.

Sentinel lymph node in patients with rectal cancer invading the anal canal.

BACKGROUND: To assess the feasibility of the sentinel lymph node procedure in patients with rectal cancer extending to the anal canal. METHODS: Between January 2005 and April 2008, 15 patients with adenocarcinoma of the rectum with direct invasion of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel node procedure consisted of a combination of preoperative radiocolloid lymphoscintigraphy and intraoperative detection of the inguinal sentinel node with a gamma probe. Patent blue dye was also used to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin-eosin staining and immunohistochemistry. RESULTS: Detection and removal of inguinal sentinel nodes was possible in all patients. Four patients (26.7%) had sentinel nodes identified as positive for metastatic adenocarcinoma. All positive cases also had metastases detected in perirectal lymph nodes; three of them developed hepatic or pulmonary metastases within 6 months after surgery. Of the 11 patients with negative sentinel nodes, only four (36.4%) also presented metastatic perirectal lymph nodes. Although none of the negative cases developed late inguinal metastases, three developed systemic or pelvic recurrence within 12 months after surgery. CONCLUSIONS: The standardized procedure was highly effective in sampling inguinal sentinel nodes in very low rectal cancers, allowing the detection of subclinical metastatic disease. Although this technique can be potentially useful for a subgroup of patients with isolated inguinal metastases, it cannot be routinely recommended for patients with rectal tumors invading the anal canal at this moment.

Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome.

OBJECTIVES: To examine, in patients with premature rupture of the amniotic membranes (PROM) at < 34 weeks of gestation, the relationship between fetal myocardial performance measured by the Tei index and fetal inflammatory response syndrome (FIRS). METHODS: A case-control study was conducted including 15 preterm PROM patients with gestational age between 24 and 33 weeks admitted to Hospital de Clínicas de Porto Alegre, and 15 controls with the same gestational age range. Fetal echocardiography with Doppler was performed at admission for the preterm PROM group, with serial examinations every 7-10 days thereafter until delivery, and at the time of inclusion in the control group. Flow velocity waveforms were obtained for the left ventricle, from which the Tei index was calculated. Placental histopathology and perinatal outcome were compared between the groups. RESULTS: The left ventricular Tei index was significantly greater in fetuses with preterm PROM compared with controls (0.63 +/- 0.13 vs. 0.51 +/- 0.10, P = 0.007). While there was no difference in isovolumetric times, the left ventricular ejection time was significantly shorter in the preterm PROM group (164 +/- 17 ms vs. 184 +/- 16 ms, P = 0.003). In the preterm PROM group, neonatal sepsis was diagnosed in 73.3%, and funisitis and chorionic vasculitis confirmed FIRS in 53.3%, compared with 6.7% for these three diagnoses in controls (P = 0.001). CONCLUSIONS: These data provide further evidence that cardiac dysfunction is present in the setting of preterm PROM. The study of myocardial performance with the Tei index is a novel non-invasive approach to assess cardiac function and monitor the fetus affected with FIRS.

Effects of chronic exposure to coal in wild rodents (Ctenomys torquatus) evaluated by multiple methods and tissues.

Rio Grande do Sul (RS) coal is low quality and typically obtained by strip mining. In a recent study concerning 2 years of biomonitoring in coal regions, we demonstrated the genotoxicity of coal and related products on blood cells of native rodents, from RS, Brazil. With the goal of studying the variations in the effects of RS coal on different tissues of the same rodent, we utilized, besides the single cell gel (SCG) and micronucleus (MN) assay on blood, histological analyses and SCG assay of bone marrow, spleen, kidney, liver and lung cells, and MN assay of bone marrow and spleen cells. In addition, to identify agents that can potentially influence the results, concentrations of several heavy metals were analyzed in livers and in soil, and the total concentration of hydrocarbons in the soil was determined. Rodents exposed to coal were captured at two different sites, Butiá and Candiota, in RS. Reference animals were obtained from Pelotas, where there is no coal mining. This report provides chemical and biological data from coal regions, indicating the possible association between Zn, Ni, Pb and hydrocarbons in the induction of DNA damage (e.g. single strand-breaks and alkali-labile sites) determined by the alkaline SCG assay in cells from Ctenomys torquatus. The results of the present SCG study indicate that coal and by-products not only induce DNA damage in blood cells, but also in other tissue cells, mainly liver, kidney and lung. Neither the MN assay nor histopathological observations showed significant differences; these analyses may be useful under circumstances where genotoxicity is higher. In conclusion we believe that the in vivo genotoxicity of coal can be biomonitored by the SCG assay, and our studies suggest that wild rodents, such as C. torquatus are useful for monitoring genotoxic damage by both methods, the SCG assay and the MN test.

Influence of surgically induced gastric and gastroduodenal content reflux on esophageal carcinogenesis--experimental model in Wistar female rats.

Studies in human beings and animals have shown that esophageal exposure to duodenal and gastric contents may be important for the development of Barrett's esophagus and its complications, including adenocarcinoma and epidermoid carcinoma. Diethylnitrosamine (DEN) is a carcinogen that stimulates the development of epidermoid carcinoma in the esophagus of mice. The aim of this study was to evaluate the effect of gastroduodenal and gastric content reflux on induction of esophageal carcinogenesis. Gastroesophageal reflux (GER) and gastroduodenoesophageal reflux (GDER) were produced by cardioplasty and esophagoduodenostomy. The chosen carcinogen was DEN, diluted in drinking water, given 3 days a week for 20 consecutive weeks. One hundred Wistar female rats were divided into six groups, as follows: group 1 (18 rats), cardioplasty without DEN; group 2 (18 rats), cardioplasty with DEN; group 3 (10 rats), only water; group 4 (17 rats), cardioplasty with DEN; group 5 (17 rats), esophagoduodenostomy with DEN; group 6 (20 rats), only DEN. GER in isolation induced papillomatosis or ulceration in 22.2% of rats and, when associated with DEN, induced papillomatosis in 61.1% of rats. GDER in isolation induced marked esophagitis in 61.1% of rats, Barrett's esophagus in 16.7% and esophageal adenocarcinoma in 16.7%; when associated with DEN, 23.5% of rats presented marked esophagitis, papillomatosis or ulceration, whereas 76.5% had esophageal carcinoma, with 70.6% epidermoid carcinoma and 5.9% adenocarcinoma. Rats treated with water alone did not show histologic abnormalities of the esophageal mucosa. Rats treated with DEN alone developed papillomas in 50.0% of the cases and remained histologically unchanged in 50.0%. There was no development of low- or high-grade dysplasia in any group. The conclusions are that (1) GDER is significantly more deleterious to esophageal mucosa than GER; (2) in this study, GER did not present carcinogenic potential in relation to the esophagus; (3) GDER in isolation is an esophageal carcinogen, producing Barrett's esophagus and esophageal adenocarcinoma; (4) esophageal oncogenesis caused by GDER is potentiated by DEN, inducing esophageal epidermoid carcinoma; (5) in this study, DEN in isolation did not generate tumors in the esophagus of rats.

Exames anatomopatológicos transoperatórios: controle de qualidade / Transoperative anatomopathological examinations: quality control

Exames transoperatórios (ET) säo realizados rotineiramente em um hospital geral, e seus resultados determinam os diferentes procedimentos cirurgicos. OBJETIVO. Avaliar o grau de precisäo diagnóstica dos ET e identificar os tipos de erros mais freqüentes. MÉtodos. Foram estudados, prospectivamente, 2.152 ET realizados entre março de 1986 e setembro de 1991, no Hospital de Clínicas de Porto Alegre (HCPA). RESULTADOS. Os 2.152 ET corresponderam a 3,7 por cento dos 58.127 exames anatomopatológicos feitos nesse período. Os erros classificados como falsos positivos ocorreram oito vezes (0,4 por cento), os falsos negativos 39 vezes (1,8 por cento) e os diagnósticos postergados para os cortes em parafina (inconclusivos) atingiram 62 casos (2,8 por cento). Os órgäos mais freqüentemente examinados foram linfonodo (19,3 por cento), ovário (17,2 por cento), mama (16,6 por cento) e tiróide (12,4 por cento). A acurácia dos ET foi de 95 por cento, e quando excluídos os 64 casos inconclusivo, a precisäo diagnóstica atingiu 97,8 por cento. CONCLUSäO. Os erros diagnósticos (2,2 por cento) encontrados nos ET realizados no HCPA säo compatíveis com os dados citados na literatura mundial, que variam entre 0,7 por cento e 2,5 por cento

[Transoperative anatomopathologic examinations: quality control]. / Exames anatomopatológicos transoperatórios: controle de qualidade.

Frozen sections (FS) are usually performed in a General Hospital and are very useful for the surgical procedure orientation. PURPOSE--To verify the accuracy of the FS performed at the Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil. METHOD--2,152 FS were carried out between March 1986-September 1991, in a prospective study. RESULTS--3.7% of the conventional pathologic examinations (58,127), performed in the same period, correspond to the FS examined. When the FS diagnosis differed from the definitive one (in paraffin) it was classified as False Positive (0.4%), False Negative (1.8%) or inconclusive (2.8%). The organs more frequently examined were lymph nodes (19.3%), ovary (17.21%), breast (16.6%) and thyroid gland (12.4%). We observed accuracy indices in 95% of the FS examined, and in 97.8% when excluding the inconclusive ones. CONCLUSION--The accuracy indices of FS performed in HCPA were similar to the ones found in the literature, which vary from 90.4% to 98.5%.