Management of the positive sentinel lymph node following neoadjuvant chemotherapy: results of a survey conducted with breast surgeons.

Introduction: Despite the lack of randomised evidence, there is a current trend towards omitting axillary surgery in cases of positive sentinel lymph node (SLN) following neoadjuvant chemotherapy (NACT). This study evaluated practice patterns of Brazilian breast surgeons when managing positive SLN following NACT. Methods: This was a nationwide electronic survey of breast surgeons affiliated with the Brazilian Society of Mastology. Management approaches for positive SLN after NACT (axillary dissection (AD), regional nodal irradiation (RNI) or no additional treatment) were evaluated as a function of residual disease volume in the SLN (macro-metastasis, micro-metastasis or isolated tumour cells (ITC)). Results: Survey response rate was 49%, with 799/1,627 questionnaires returned. Most respondents were <50 years old (61%), lived in south-eastern Brazil (50%), in a major city (67%), worked in an academic institute (80%) and were board-certified (80%). AD recommendation rate decreased according to residual nodal disease volume: 91% of respondents recommended AD for cases of macro-metastasis, 64% for micro-metastasis and 38% for ITC (p < 0.00001). Furthermore, 35% would recommend no additional surgery for micro-metastasis, while 27% would recommend no treatment at all for ITC (p < 0.00001). Not working in an academic institute was associated with RNI for micro-metastasis (p = 0.02), but not for macro-metastasis or ITC. Being board-certified did not affect axillary management. Conclusion: Most respondents would recommend AD and/or RNI in residual nodal disease following NACT irrespective of disease volume. Nevertheless, a trend towards surgical de-escalation was found with low-volume disease (micro-metastasis and ITC). Ongoing randomised trials will clarify the impact of this trend.

The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer-10 Years after the ACOSOG Z0011 Trial First Publication.

PURPOSE: To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020. PATIENTS AND METHODS: A survey of members of the Brazilian Society of Mastology. RESULTS: Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old. CONCLUSIONS: This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.

Supercritical Extraction of Red Propolis: Operational Conditions and Chemical Characterization.

The objective of this study was to determine the best operational conditions for obtaining red propolis extract with high antioxidant potential through supercritical fluid extraction (SFE) technology, using carbon dioxide (CO2) as the supercritical fluid and ethanol as the cosolvent. The following parameters were studied: overall extraction curve, S/F (mass of CO2/mass of sample), cosolvent percentage (0, 1, 2 and 4%) and global yield isotherms as a function of different pressures (250, 350 and 450 bar) and temperatures (31.7, 40 and 50 °C). Within the investigated parameters, the best conditions found were an S/F of 131 and the use of ethanol at the highest concentration (4% w/w), which resulted in higher extract yields and higher content of antioxidant compounds. Formononetin, the main biomarker of red propolis, was the compound found at the highest amounts in the extracts. As expected, the temperature and pressure conditions also influenced the process yield, with 350 bar and 40 °C being the best conditions for obtaining bioactive compounds from a sample of red propolis. The novel results for red propolis found in this study show that it is possible to obtain extracts with high antioxidant potential using a clean technology under the defined conditions.

Biscuit residue in the nutrition of laying hens: effects on animal health, performance and egg quality

Background: Corn and soybean meal are common ingredients used in poultry feed in order to supply the demand forenergy and protein, respectively. Also, these ingredients directly influence the final price of the diets, and consequently,the final cost of production. A major problem is associated to the oscillation of these grains in some months of the year.Therefore, there is a need to search for nutritionally and economically viable alternatives to mitigate this problem. The aimwas to evaluate whether the addition of biscuit residue could partially replace the use of corn in the feed of laying hens inorder to obtain economic viability without impairment on production, egg quality and animal health.Materials, Methods & Results: The experiment was completely randomized and each repetition was considered one experimental unity. One hundred Hy-line brown 48 week-old chickens were allocated in cages and divided into five groupswith four repetitions each, allocating five animals per cage. The group T0 was composed by animals that received thebasal diet, i.e. without biscuit residue. The other groups were composed by increasing levels of biscuit residue to substitutecorn i.e., group T7 (7% of biscuit residue), T14 (14% of biscuit residue), T21 (21% of biscuit residue) and T28 (28% ofbiscuit residue). Productive performance of the animals, egg quality, as well as analysis of blood parameters related tolipid metabolism, carbohydrates and proteins of birds were measured at the beginning of the experiment (day 0) and atthe end of each cycle (days 21, 42 and 63 of experiment). Among the performance variables, only feed conversion wasaltered by biscuit residue, i.e., the feed conversion was lower in the groups that received the residue when compared tothe control. The replacement of corn by biscuit residue did not affect laying rate (P > 0.05). Regarding egg quality, a less...(AU)

Biscuit residue in the nutrition of laying hens: effects on animal health, performance and egg quality

Background: Corn and soybean meal are common ingredients used in poultry feed in order to supply the demand forenergy and protein, respectively. Also, these ingredients directly influence the final price of the diets, and consequently,the final cost of production. A major problem is associated to the oscillation of these grains in some months of the year.Therefore, there is a need to search for nutritionally and economically viable alternatives to mitigate this problem. The aimwas to evaluate whether the addition of biscuit residue could partially replace the use of corn in the feed of laying hens inorder to obtain economic viability without impairment on production, egg quality and animal health.Materials, Methods & Results: The experiment was completely randomized and each repetition was considered one experimental unity. One hundred Hy-line brown 48 week-old chickens were allocated in cages and divided into five groupswith four repetitions each, allocating five animals per cage. The group T0 was composed by animals that received thebasal diet, i.e. without biscuit residue. The other groups were composed by increasing levels of biscuit residue to substitutecorn i.e., group T7 (7% of biscuit residue), T14 (14% of biscuit residue), T21 (21% of biscuit residue) and T28 (28% ofbiscuit residue). Productive performance of the animals, egg quality, as well as analysis of blood parameters related tolipid metabolism, carbohydrates and proteins of birds were measured at the beginning of the experiment (day 0) and atthe end of each cycle (days 21, 42 and 63 of experiment). Among the performance variables, only feed conversion wasaltered by biscuit residue, i.e., the feed conversion was lower in the groups that received the residue when compared tothe control. The replacement of corn by biscuit residue did not affect laying rate (P > 0.05). Regarding egg quality, a less...

Evaluation of the antioxidant profile and cytotoxic activity of red propolis extracts from different regions of northeastern Brazil obtained by conventional and ultrasound-assisted extraction.

Propolis is a complex mixture of resinous and balsamic material collected from the exudates of plants, shoots, and leaves by bees. This study evaluated red propolis extracts obtained by conventional (ethanolic) extraction and ultrasound-assisted extraction of six samples from different regions of northeastern Brazil. The total phenolic compounds and flavonoids, in vitro antioxidant activity, concentration of formononetin and kaempferol and the cytotoxicity against four human tumor cell lines were determined for all twelve obtained extracts. Significant variations in the levels of the investigated compounds were identified in the red propolis extracts, confirming that the chemical composition varied according to the sampling region. The extraction method used also influenced the resulting propolis compounds. The highest concentration of the compounds of interest and the highest in vitro antioxidant activity were exhibited by the extracts obtained from samples from state of Alagoas. Formononetin and kaempferol were identified in all samples. The highest formononetin concentrations were identified in extracts obtained by ultrasound, thus indicating a greater selectivity for the extraction of this compound by this method. Regarding cytotoxic activity, for the HCT-116 line, all of the extracts showed an inhibition of greater than 90%, whereas for the HL-60 and PC3 lines, the minimum identified was 80%. In general, there was no significant difference (p>0.05) in the antiproliferative potential when comparing the extraction methods. The results showed that the composition of Brazilian red propolis varies significantly depending on the geographical origin and that the method used influences the resulting compounds that are present in propolis. However, regardless of the geographical origin and the extraction method used, all the red propolis samples studied presented great biological potential and high antioxidant activity. Furthermore, the ultrasound-assisted method can be efficiently applied to obtain extracts of red propolis more quickly and with high concentration of biomarkers of interest.

Technological Potential of Avocado Oil: Prospective Study Based on Patent Documents.

BACKGROUND: Avocado (Persea Americana, Mill.), belonging to the Lauraceae family, is considered a tropical fruit originating in Central America, with Mexico being the largest producer in the world. The fruit stands out for its economic potential and high nutritional value and its oil has good commercial value, however, its production is still incipient, being mainly used by the pharmaceutical and cosmetic industries. Despite producing a significant amount of oil, the avocado seed is still considered a by-product of fruit processing. METHODS: Thus, the objective of this work was to evaluate the technological potential of the oil obtained from the avocado and avocado seed through the research and analysis of patent documents available worldwide, in order to identify the main countries that have the technology researched as well as, the main areas of application. We revised all the patents related to acquisition, application and the use of avocado oil. For this, a search was carried out for the database of the Derwent Innovation Index (DII), which compiles the collection of documents published around the world. RESULTS: A total of 144 patent documents were identified, which were evaluated for the country of origin of thepublisher, the type of thepublisher, inventors, rate of publication over time and areas of application. There has been an increase in the number of patents producded as of 2011, which proves it to be a current and interesting technology. The main countries were the United States and the European Union. CONCLUSION: The documents identified referred to different processes applied to obtain oil, as well as the application for the development of new food, cosmetic and veterinary products. In this way, although incipient, the researched technology proved to be a promising area of research to be explored by universities and companies in view of the characteristics and potential of the product.

Effect of Cellulose Nanocrystals from Different Lignocellulosic Residues to Chitosan/Glycerol Films.

Interest in nanocellulose obtained from natural resources has grown, mainly due to the characteristics that these materials provide when incorporated in biodegradable films as an alternative for the improvement of the properties of nanocomposites. The main purpose of this work was to investigate the effect of the incorporation of nanocellulose obtained from different fibers (corncob, corn husk, coconut shell, and wheat bran) into the chitosan/glycerol films. The nanocellulose were obtained through acid hydrolysis. The properties of the different nanobiocomposites were comparatively evaluated, including their barrier and mechanical properties. The nanocrystals obtained for coconut shell (CS), corn husk (CH), and corncob (CC) presented a length / diameter ratio of 40.18, 40.86, and 32.19, respectively. Wheat bran (WB) was not considered an interesting source of nanocrystals, which may be justified due to the low percentage of cellulose. Significant differences were observed in the properties of the films studied. The water activity varied from 0.601 (WB Film) to 0.658 (CH Film) and the moisture content from 15.13 (CS Film) to 20.86 (WB Film). The highest values for tensile strength were presented for CC (11.43 MPa) and CS (11.38 MPa) films, and this propriety was significantly increased by nanocellulose addition. The results showed that the source of the nanocrystal determined the properties of the chitosan/glycerol films.

Lipid content and fatty acids compositions in commercial cuts of young goat meat / Teor lipídico e perfil de ácidos graxos de cortes comerciais de carne de caprinos juvenis

Brazil has the largest herd of goats of the American continent, with more than 9 million head. Goat farming is considered a growing and important activity for the economy, mainly in the northeastern region of Brazil .In this research, were determined the lipid content and the composition of fillet and shank fatty acids of young goats, registered in the inspection sector of the Ministry of Agriculture and marketed in the city of Salvador (Bahia). The average percentage of total lipids in the fillet was 1.68±0.04 and in the shank of 4.02±0.09, this is a significant difference between the cuts (P<0.05). Twenty-seven (27) fatty acids were identified in the cuts, most are palmitic acid (C16:0), stearic acid (C18:0) and oleic acid (C18:1ω9) present in 21.32%, 20.39%, 34.49% in the fillet and 21.74%, 21.94%, 33.38% in the shank, respectively. The total sums of saturated and polyunsaturated fatty acids ranged of 42.75 to 45.23% and 14.04 to 12.35% between fillet and shank cuts, respectively. The ratio of PUFA/SFA was 0.35 for fillet and 0.15 for shank, and the ratio ω6/ω3 was 3.07 for fillet and 2.27 for shank. Therefore, is a significant difference in total lipid content and fatty acid composition in commercial cuts of beef fillet and shank.(AU)

O Brasil apresenta a maior população de caprinos do continente americano, com mais de nove milhões de cabeças, a caprinocultura é considerada uma atividade em ascensão e de grande importância para a economia, principalmente da região nordeste. No presente trabalho foram determinados o teor de lipídios totais e o perfil de ácidos graxos de amostras de filé e pernil de caprinos juvenil, registrados em órgãos de inspeção do Ministério da Agricultura e comercializados na cidade de Salvador (Bahia). O percentual médio de lipídios totais no filé foi de 1,68±0,04 e no pernil de 4,02±0,09, com diferenças significativas entre os cortes (p<0,05). Foram identificados nos cortes, vinte e sete ácidos graxos, sendo os majoritários os ácidospalmítico (C16:0), esteárico (C18:0) e oleico (C18:1ω9) presentes em 21,32%, 20,39%, 34,49% no filé, e 21,74%, 21,94%, 33,38% no pernil, respectivamente. Os somatórios totais de ácidos graxos saturados e poli-insaturados variaram de 42,75 a 45,23% e de 14,04 a 12,35%, entre os cortes de filé e de pernil, respectivamente. A razão entre AGPI/AGS foi de 0,35 para o filé e de 0,15 para o pernil, e a razão ω6/ω3 foi de 3,07 para o filé e de 2,27 para o pernil. Constatou-se que existe uma diferença significativa no teor de lipídios totais e da composição de ácidos graxos em cortes comerciais de filé e pernil de carne caprina.(AU)

Outcomes after knee arthroplasty in extra-articular deformity.

PURPOSE: To assess functional outcomes in patients undergoing total knee arthroplasty (TKA) without previous corrective osteotomy for treatment of knee osteoarthritis associated with extra-articular deformity. METHODS: From January to December 2016, patients with knee osteoarthritis with extra-articular deformities who presented for preoperative assessment before TKA were evaluated prospectively. Physical and radiological characteristics were documented pre- and postoperatively. RESULTS: TKA was performed in 33 knees; 25 were considered for analysis. The mean age was 65.2 years (range, 48-79 years). Sixteen deformities were secondary to fractures and nine to failed osteotomies. The mean Knee Society Score (KSS) improved from 27.1 pre-operatively to 68.7 post-operatively (p = 0.000). Pre-operative mechanical axis ranged from 32° varus (negative) to 26° valgus. After correction, 20 knees were within 3° (varus or valgus) of mechanical alignment. CONCLUSION: In patients with extra-articular deformities, TKA with asymmetric intra-articular resection and ligament balancing can relieve pain and realign the mechanical axis of the lower limb.

Lipid content and fatty acids compositions in commercial cuts of young goat meat / Teor lipídico e perfil de ácidos graxos de cortes comerciais de carne de caprinos juvenis

ABSTRACT: Brazil has the largest herd of goats of the American continent, with more than 9 million head. Goat farming is considered a growing and important activity for the economy, mainly in the northeastern region of Brazil .In this research, were determined the lipid content and the composition of fillet and shank fatty acids of young goats, registered in the inspection sector of the Ministry of Agriculture and marketed in the city of Salvador (Bahia). The average percentage of total lipids in the fillet was 1.68±0.04 and in the shank of 4.02±0.09, this is a significant difference between the cuts (P<0.05). Twenty-seven (27) fatty acids were identified in the cuts, most are palmitic acid (C16:0), stearic acid (C18:0) and oleic acid (C18:1ω9) present in 21.32%, 20.39%, 34.49% in the fillet and 21.74%, 21.94%, 33.38% in the shank, respectively. The total sums of saturated and polyunsaturated fatty acids ranged of 42.75 to 45.23% and 14.04 to 12.35% between fillet and shank cuts, respectively. The ratio of PUFA/SFA was 0.35 for fillet and 0.15 for shank, and the ratio ω6/ω3 was 3.07 for fillet and 2.27 for shank. Therefore, is a significant difference in total lipid content and fatty acid composition in commercial cuts of beef fillet and shank.

RESUMO: O Brasil apresenta a maior população de caprinos do continente americano, com mais de nove milhões de cabeças, a caprinocultura é considerada uma atividade em ascensão e de grande importância para a economia, principalmente da região nordeste. No presente trabalho foram determinados o teor de lipídios totais e o perfil de ácidos graxos de amostras de filé e pernil de caprinos juvenil, registrados em órgãos de inspeção do Ministério da Agricultura e comercializados na cidade de Salvador (Bahia). O percentual médio de lipídios totais no filé foi de 1,68±0,04 e no pernil de 4,02±0,09, com diferenças significativas entre os cortes (p<0,05). Foram identificados nos cortes, vinte e sete ácidos graxos, sendo os majoritários os ácidospalmítico (C16:0), esteárico (C18:0) e oleico (C18:1ω9) presentes em 21,32%, 20,39%, 34,49% no filé, e 21,74%, 21,94%, 33,38% no pernil, respectivamente. Os somatórios totais de ácidos graxos saturados e poli-insaturados variaram de 42,75 a 45,23% e de 14,04 a 12,35%, entre os cortes de filé e de pernil, respectivamente. A razão entre AGPI/AGS foi de 0,35 para o filé e de 0,15 para o pernil, e a razão ω6/ω3 foi de 3,07 para o filé e de 2,27 para o pernil. Constatou-se que existe uma diferença significativa no teor de lipídios totais e da composição de ácidos graxos em cortes comerciais de filé e pernil de carne caprina.

The protective effects of an adsorbent against oxidative stress in quails fed aflatoxin-contaminated diet

Background: Contamination of crops with aflatoxin is considered a serious global threat to food safety, since potent carcinogenic, teratogenic, mutagenic and immunosuppressive effects of aflatoxins are well recognized. Recently, the use of adsorbents has been linked with protective effects against oxidative stress in several diseases. Thus, the aim of this study was to assess the occurrence of oxidative stress in quails (Coturnix coturnix) fed with aflatoxin-contaminated diet, as well as the protective effect of an adsorbent.Materials, Methods & Results: Twenty-eight quails were divided into four groups (n = 7): diet without additives (control; the group A), diet and adsorbent containing aluminosilicates (the group B), aflatoxin-contaminated diet (200 ppb) (the group C), and aflatoxin-contaminated diet (200 ppb) and adsorbent containing aluminosilicates (the group D). The composition of the adsorbent containing aluminosilicates was 0.3% based on yeast cell wall, silymarin, and bentonite. The animals received feed and water ad libitum during 20 days. At the end of the experimental period, total blood was collected by cardiac puncture in tubes without anticoagulant to obtain serum (centrifuged at 3500 g during 10 min) for later determination of biochemical parameters. The liver was placed in a solution of Tris–HCl 10 mM, pH 7.4 for TBARS (Thiobarbituric acid reactive substances), ROS (Reactive oxygen species), SOD (Superoxide dismutase) and CAT (Catalase) analysis. The hepatic tissue was gently homogenized in a glass potter in specific buffer, homogenated, and centrifuged at 10.000 g at 4ºC for 10 min to yield a supernatant (S1) used for analyses. Homogenate aliquots were stored at -80°C until utilization. Fragments of liver and intestine (5 cm) were collected for histopathological analyses. Between days 15 to 20 of the experiment, group C quails showed clinical signs, such as apathy, creepy feathers and reduced feed intake.[...](AU)

The protective effects of an adsorbent against oxidative stress in quails fed aflatoxin-contaminated diet

Background: Contamination of crops with aflatoxin is considered a serious global threat to food safety, since potent carcinogenic, teratogenic, mutagenic and immunosuppressive effects of aflatoxins are well recognized. Recently, the use of adsorbents has been linked with protective effects against oxidative stress in several diseases. Thus, the aim of this study was to assess the occurrence of oxidative stress in quails (Coturnix coturnix) fed with aflatoxin-contaminated diet, as well as the protective effect of an adsorbent.Materials, Methods & Results: Twenty-eight quails were divided into four groups (n = 7): diet without additives (control; the group A), diet and adsorbent containing aluminosilicates (the group B), aflatoxin-contaminated diet (200 ppb) (the group C), and aflatoxin-contaminated diet (200 ppb) and adsorbent containing aluminosilicates (the group D). The composition of the adsorbent containing aluminosilicates was 0.3% based on yeast cell wall, silymarin, and bentonite. The animals received feed and water ad libitum during 20 days. At the end of the experimental period, total blood was collected by cardiac puncture in tubes without anticoagulant to obtain serum (centrifuged at 3500 g during 10 min) for later determination of biochemical parameters. The liver was placed in a solution of Tris–HCl 10 mM, pH 7.4 for TBARS (Thiobarbituric acid reactive substances), ROS (Reactive oxygen species), SOD (Superoxide dismutase) and CAT (Catalase) analysis. The hepatic tissue was gently homogenized in a glass potter in specific buffer, homogenated, and centrifuged at 10.000 g at 4ºC for 10 min to yield a supernatant (S1) used for analyses. Homogenate aliquots were stored at -80°C until utilization. Fragments of liver and intestine (5 cm) were collected for histopathological analyses. Between days 15 to 20 of the experiment, group C quails showed clinical signs, such as apathy, creepy feathers and reduced feed intake.[...]

Avaliação de biomarcadores de risco em pacientes com anemia falciforme em crise vaso-oclusiva / Evaluation of biomarkers of risk in sickle cell patients in vaso-occlusive crisis

Os indivíduos com anemia falciforme (HbSS) possuem quadro clínico heterogêneo, com alterações múltiplas em órgãos ou tecidos, que são secundárias a hemólise contínua e aos fenômenos de vaso-oclusão, sendo estes últimos decorrentes da falcização dos eritrócitos e da ativação de moléculas na superfície de leucócitos, plaquetas e células endoteliais, além do aumento de proteínas plasmáticas inflamatórias. O presente estudo teve como objetivo avaliar biomarcadores relacionados ao prognóstico em pacientes HbSS hospitalizados em crise e no estado estável, de maneira a identificar marcadores de risco para cada uma dessas fases da doença. A casuística foi composta por 31 pacientes HbSS em crise e 45 em estado estável provenientes do hospital pediátrico das Obras Sociais irmã Dulce (HPOSID) e da Fundação de Hematologia e Hemoterapia do estado da Bahia (HEMOBA), respectivamente. O estudo foi aprovado pelo CEP do CPqGM da FIOCRUZ e os dados clínicos foram obtidos a partir da consulta aos prontuários médicos. A dosagem sorológica de citocinas, quimiocinas e moléculas de adesão (ICAM-1s e VCAM-1s) solúveis foram realizadas pela reação de ELISA. A análise de moléculas na superfície dos leucócitos foi investigada por citometria de fluxo. A citocina IL-1β teve correlação negativa significativa com a fração de LDL-c (r=0,450, p=0,011) nos pacientes HbSS em crise. Correlações positivas significativas foram observadas para a análise entre VCAM-1s e ácido úrico (r=0,547, p=0,002), triglicérides e IL6 (r=0,547, p=0,00). Em relação ao parâmetro HDL-c foi verificado que os pacientes que apresentaram níveis menores do que a média (percentil <50) tiveram risco de 11,6 vezes maior de desenvolver vaso-oclusão. Os pacientes HbSS que apresentaram níveis ≥ a média (percentil ≥50) das citocinas IL-12 e IL-8 tiveram risco maior para o desenvolvimento de crise álgica. Os pacientes HbSS em crise apresentaram níveis mais elevados para a AST e LDH quando comparados aos pacientes HbSS no estado estável; e os níveis de colesterol total, HDL-c e LDL-c foram menores nos pacientes HbSS em crise que nos pacientes no estado estável. Os níveis da citocina TNF-α estiveram associados aos níveis elevados de VCAM-1s, IL-1 e IL-10 nos pacientes em crise, quando comparados aos pacientes no estado estável. Com base nos resultados, pode-se concluir que a citocina TNF-α está associada a elevação sérica de VCAM-1s nos pacientes HbSS em crise; o nível de triglicerídeos foi considerado fator protetor para o desenvolvimento de infecção nos pacientes HbSS em crise. Os pacientes que apresentaram níveis menores do que a média de HDL-c tiveram risco maior para o desenvolvimento de vaso-oclusão. Os pacientes HbSS que apresentaram níveis superiores a média de VCAM-1s apresentaram risco elevado para vaso-oclusão, tanto no estado estável quanto em crise. Verificou-se que existe correlação positiva significativa entre ácido úrico e VCAM-1s. Em conjunto, os nossos resultados indicam que moléculas distintas estão associadas ao período estável e de crise nas duas fases da HbSS investigadas, de forma a constituirem elementos importantes para estratégias voltadas ao desenho de fármacos e ao monitoramento clínico destes pacientes.

Síndromes genéticas associadas ao câncer de mama: avaliação e aconselhamento / Genetic syndromes leading to breast cancer: assessment and counseling

Mulheres em todas as categorias de risco estão buscando informações sobre seus riscos individuais de desenvolverem câncer de mama. Logo, faz-se necessário, para seus cuidados clínicos iniciais, avaliar os fatores de risco em suas famílias, fornecer informação individualizada do risco e oferecer recomendações de acompanhamento. Estimativas do número de mulheres com história familiar de câncer de mama variam de aproximadamente 5 a 10 porcento, dependendo da população pesquisada. Muitas dessas mulheres não apresentarão história familiar que sugira a presença do gene altamente penetrante de suscetibilidade ao câncer de mama. Entretanto, um pequeno subgrupo virá de famílias com alta incidência de câncer de mama e outros cânceres freqüentemente associados a mutações hereditárias. Este trabalho apresenta os cuidados clínicos que podem ser de grande valia para se definirem as famílias como de risco moderado ou alto, a avaliação e o aconselhamento para essas mulheres

Women in all risk categories are seeking information regarding their individual breast cancer risk, and there is a need for their primary care clinicians to be able to assess familial risk factors for breast cancer, provide individualized risk information, and offer surveillance recommendations. Estimates of the number of women with a family history of breast cancer range from approximately 5 percent to 10 percent, depending on the population surveyed. Many of these women will not have a family history that suggests the presence of a highly penetrant breast cancer susceptibility gene. However, a small subset of such women will come from families with a striking incidence of breast and other cancers often associated with inherited mutations. We present the care clinicians that may be helpful in defining families as moderate or high risk and the assessment and counseiling for these women

A comparision of aspiration cytology and core needle biopsy according to tumor size of suspicious breast lesions.

The purpose of the study was to compare the accuracy of FNAC, CNB, and combined biopsy according to tumor size of suspicious breast lesions. FNAC and CNB were performed in 264 patients with suspicious breast lesions from August, 1997 to August, 2002. The procedures were guided by ultrasound and performed in the same session by the same operator. The lesions were divided in four groups according to the tumor size in the histopathology report: lesions smaller than 1 cm, between 1 and 2 cm, between 2 and 5 cm, and lesions greater than 5 cm. The final surgical histopatology results identified 222 (84%) malignant cases and benign lesions summed 42 (16%). For lesions smaller than 1 cm, FNAC, CNB, and combined biopsy were equivalent for all parameters. For lesions between 1 and 2 cm, FNAC and CNB were equivalent. Combined biopsy showed higher absolute sensitivity (P = 0.007) and lower inadequate rate (P = 0.03) when compared to FNAC. However, when combined biopsy and CNB were compared, no difference were found. For lesions between 2 and 5 cm, CNB showed higher absolute sensitivity (P < 0.001) and lower inadequate rate (P < 0.007) when compared to FNAC. Combined biopsy showed higher sensitivity compared to FNAC and CNB alone (P < 0.05) in this group. For lesions greater than 5 cm, FNAC and CNB were equivalent for all parameters. Combined biopsy only showed higher absolute sensitivity (P = 0.04) when compared with FNAC alone. The combination of FNAC and CNB can improve the diagnosis of suspicious breast lesions higher than 1 cm. However, for lesions smaller than 1 cm, our results showed no difference between FNAC, CNB, and combined biopsy, for these lesions any modality has technical limitations.

Cirurgias radioguiadas em mastologia / Radioguided surgery in mastology

As técnicas conjuntas da mastologia, com auxílio da medicina nuclear, representam um importante papel na atualidade. A investigação das lesões não palpáveis da mama, através das cirurgias radioguiadas (ROLL), e a possibilidade da cirurgia conservadora da axila, através da análise do linfonodo sentinela (LS), são avanços tecnológicos disponíveis e cada vez mais utilizados na prática clínica. A utilização destas duas técnicas conjugadas (SNOLL) procura associar as facilidades do ROLL com os benefícios do linfonodo sentinela uma vez que o amplo uso dos métodos invasivos para diagnóstico do câncer de mama como o PAAF, core biopsy e mamotomia permitem o planejamento cirúrgico definitivo e simultâneo do tumor e da axila.

Ambulatório periférico de Ginecologia. Revisäo de 570 pacientes encaminhadas para anticoncepçäo / Gynecological clinic. Review of 570 patients counseling for family planning

Os autores analisam 570 papeletas de pacientes que procuraram o ambulatório para planejamento familiar da Igreja do Carmo de Belo Horizonte, que está vinculado ao Hospital Mater Dei e ao Centro de Pesquisas Clóvis Salgado (CEP ECS), no período de setembro de 1985 a junho de 1993. Säo avaliados aspectos epidemiológicos como a idade, raça, paridade, abortos, menarca, periodicidade dos ciclos menstruais, queixas menstruais, métodos anticoncepcionais mais utilizados e intercorrências ginecológicas. A média etária foi de 25,48 (ñ 5,86) anos; a paridade média foi de 1,51 (ñ 1,78); a média de abortos foi de 0,26 sendo que 29,9 por cento foram abortos provocados, correspondendo a 5,08 por cento do número total de pacientes; a idade média da primeira gestaçäo foi de 20,35 (ñ 3,87) anos e da menarca, de 13,21 (ñ 1,76) anos; os parâmetros clínicos menstruais se mantiveram dentro da normalidade; 22,4 por cento apresentaram algum grau de irregularidade menstrual; o método anticoncepcional mais prescrito foi o anticoncepcional hormonal oral (66,8 por cento). Foram observados baixos índices de salpingotripsia (3,3 por cento) que se devem ao fato de o ambulatório näo fornecer este método sendo as pacientes encaminhadas para serviços secundários. Acreditamos que o planejamento familiar ainda näo é praticado na sua plenitude no Brasil.

Intercorrências mamárias em måes de recém-nascidos de alto-risco / Breast-feeding disturbances in mothers of high-risk newborns

Os autores avaliam os distúrbios da lactaçåo ocorridos em pacientes cujos recém-nascidos necessitaram de uma Unidade de Tratamento Intensivo Pediátrico (UTIP) e descrevem as técnicas adotadas pela equipe de enfermagem do Hospital Mater Dei para orientaçåo a respeito de aleitamento materno para estas puérperas. A idade materna média foi de 27 anos e a paridade média, de dois filhos. A orientaçåo a respeito do aleitamento materno durante o pré-natal foi relatado por 72,2 por cento das pacientes e 74,4 por cento relataram orientaçåo pela enfermagem do hospital. Cerca de 67 por cento das pacientes apresentaram algum distúrbio mamário físico ou alteraçåo emocional importante o bastante para prejudicar o tempo total de amamentaçåo

Adenomiose: estudo clínico e histopatológico de 352 casos / Adenomyosis: histopathological and clinical study of 352 cases

Foram estudadas 953 peças cirúrgicas, pós-histerectomias, realizadas no Hospital Mater Dei, Belo Horizonte, no período de junho de 1982 a julho de 1990; 352 (36,9 por cento) casos de adenomiose foram selecionados para o estudo. A idade das pacientes variou de 29 a 81 anos (X = 45 anos), 94,7 por cento tinha um ou mais partos. Os sintomas clínicos mais freqüentes foram: sangramento uterino näo habitual (75 por cento), dismenorréia (28,5 por cento), dor pélvica (22,8 por cento) e dispareunia (10,6 por cento). Achados histopatológicos associados foram encontrados em 76 por cento dos casos, com maior freqüência para miomatose (50 por cento) e hiperplasia endometrial (34 por cento). A presenta de cirurgia uterina anterior em alguns casos - 31 por cento cesareanas e 23,5 por cento de curetagens - näo é suficiente para afirmar-mos qua a presenta de traumatismo uterino teria influência na gênese da adenomiose. O uso de estrogênios por mais de dois anos em 13 por cento dos casos também näo é conclusivo para se tentar explicar a gênese da adenomiose. Os autores observam a importância de se considerar a adenomiose nos casos de sintomatologia sugestiva, e a necessidade de mais estudos dessa patologia para uma maior acuracidade diagnóstica e terapêutica.