Association of Fibrinolytic Potential and Risk of Mortality in Cancer Patients.

Cancer is a leading cause of death, and the fibrinolytic system shows cooperative effects that facilitate the growth of tumors and the appearance of metastases. This prospective study aimed to evaluate the fibrinolytic potential in cancer patients and its association with mortality outcomes using the fluorometric method of simultaneous thrombin and plasmin generation. The study included 323 cancer patients and 148 healthy individuals. During the 12-month follow-up, 68 patients died. Compared to the control group, cancer patients showed alterations in thrombin production consistent with a hypercoagulability profile, and an increase in plasmin generation. Mortality risk was associated with two parameters of thrombin in both univariate and multivariable analysis: maximum amplitude (Wald 11.78, p < 0.001) and area under the curve (Wald 8.0, p < 0.005), while such associations were not observed for plasmin. In conclusion, this was the first study able to demonstrate the simultaneous evaluation of thrombin and plasmin generation in newly diagnosed untreated cancer patients. Patients with cancer have been observed to exhibit a hypercoagulable profile. During the study, two parameters linked to thrombin generation, MA and AUC, were identified and found to have a potential association with mortality risk. However, no associations were found with parameters related to plasmin generation.

Detection of Pneumocystis jirovecii by nested PCR in HIV-negative patients with pulmonary disease / Detección de Pneumocystis jirovecii mediante PCR anidada en pacientes VIH negativos con enfermedad pulmonar

Background. Nested PCR can be used to determine the status of Pneumocystis jirovecii infection in other lung diseases. Aims. This study sought to detect a target DNA fragment (mitochondrial large subunit rRNA or mtL SUrRNA) of P. jirovecii in patients with lung disease who underwent bronchoscopy with collection of bronchoalveolar lavage (BAL). Methods. The results from toluidine blue staining were compared with those obtained using molecular methods that included an «in house» DNA extraction procedure, PCR and nested PCR. Results. Fifty-five BAL samples from patients with atypical chest X-rays were screened for P. jirovecii. None of the samples was positive for P. jirovecii using toluidine blue staining. In contrast, P. jirovecii DNA was detected by nested PCR in BAL samples from 36 of 55 patients (65.5%). The lung diseases in the patients included cancer, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD). Other chronic problems in the patients included hypertension, diabetes, smoking, and alcoholism. Conclusions. Nested PCR showed high sensitivity for detecting P. jirovecii, especially when compared with toluidine blue staining. Using this method, P. jirovecii infection was detected in HIV-negative patients with lung disease (AU)

Antecedentes. El diagnóstico de laboratorio mediante la técnica de PCR anidada permite determinar estados de infección por Pneumocystis jirovecii en otras enfermedades pulmonares. Objetivos. El objetivo de este estudio fue detectar fragmentos de ADN mitocondrial (mtLSU rRNA) de P. jirovecii en muestras de lavado broncoalveolar (LBA) de pacientes con enfermedades pulmonares, sometidos a broncoscopia. Métodos. Se compara la técnica de coloración con azul de toluidina para la microscopia, con los métodos moleculares PCR y PCR anidada; se realizó una extracción in house de ADN para las reacciones moleculares. Resultados. La presencia de P. jirovecii fue estudiada en 55 muestras de LBA de pacientes que presentaron patrones radiográficos de tórax atípicos. Ninguna de las muestras fue positiva para P. jirovecii con la técnica de coloración con azul de toluidina. Por la técnica de PCR anidada se detectó el ADN de P. jirovecii en 36 de los 55 pacientes (65,5%). Las enfermedades pulmonares de los pacientes fueron cáncer, neumonía, tuberculosis y enfermedad pulmonar obstructiva crónica (EPOC). Las otras enfermedades crónicas presentadas por los pacientes fueron hipertensión, diabetes, alcoholismo y tabaquismo. Conclusiones. La PCR anidada mostró ser altamente sensible en la detección de P. jirovecii en comparación con la coloración por azul de toluidina. Este método permite detectar infecciones por P. jirovecii en pacientes VIH negativos con enfermedades pulmonares (AU)

Detection of Pneumocystis jirovecii by nested PCR in HIV-negative patients with pulmonary disease.

BACKGROUND: Nested PCR can be used to determine the status of Pneumocystis jirovecii infection in other lung diseases. AIMS: This study sought to detect a target DNA fragment (mitochondrial large subunit rRNA or mtL SUrRNA) of P. jirovecii in patients with lung disease who underwent bronchoscopy with collection of bronchoalveolar lavage (BAL). METHODS: The results from toluidine blue staining were compared with those obtained using molecular methods that included an "in house" DNA extraction procedure, PCR and nested PCR. RESULTS: Fifty-five BAL samples from patients with atypical chest X-rays were screened for P. jirovecii. None of the samples was positive for P. jirovecii using toluidine blue staining. In contrast, P. jirovecii DNA was detected by nested PCR in BAL samples from 36 of 55 patients (65.5%). The lung diseases in the patients included cancer, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD). Other chronic problems in the patients included hypertension, diabetes, smoking, and alcoholism. CONCLUSIONS: Nested PCR showed high sensitivity for detecting P. jirovecii, especially when compared with toluidine blue staining. Using this method, P. jirovecii infection was detected in HIV-negative patients with lung disease.

Descriptive analysis of and overall survival after surgical treatment of lung metastases / Analise descritiva e sobrevida global do tratamento cirurgico das metastases pulmonares

OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases. .

OBJETIVO: Descrever características demográficas, resultados operatórios, complicações pós-operatórias e taxa de sobrevida global em pacientes com metástases pulmonares tratados cirurgicamente. MÉTODOS: Análise retrospectiva de 119 pacientes submetidos a um total de 154 cirurgias de ressecção de metástase pulmonar entre 1997 e 2011. RESULTADOS: Do total de 119 pacientes, 68 (57,1%) eram do sexo masculino, e 108 (90,8%) eram brancos. A mediana de idade foi de 52 anos (variação, 15-75 anos). Nessa amostra, 63 pacientes (52,9%) apresentaram comorbidades, sendo as mais frequentes hipertensão arterial sistêmica (69,8%) e diabetes (19,0%). Tumores primários colorretais (47,9%) e musculoesqueléticos (21,8%) foram os principais sítios de origem das metástases. Aproximadamente 24% dos pacientes foram submetidos a mais de uma ressecção das lesões, e 71% fizeram tratamento adjuvante prévio à metastasectomia. A taxa de recidiva de metástase pulmonar foi de 19,3%. A mediana do intervalo livre de doença foi de 23 meses. A principal via de acesso usada foi toracotomia (78%), e o tipo de ressecção mais frequente foi em cunha e segmentectomia (51%). O índice de complicações pós-operatórias foi de 22% e o de mortalidade perioperatória foi de 1,9%. As taxas de sobrevida global em 12, 36, 60 e 120 meses foram, respectivamente, de 96%, 77%, 56% e 39%. A análise de Cox confirmou que complicações nos primeiros 30 dias pós-operatórios associaram-se a pior prognóstico (hazard ratio = 1,81; IC95%: 1,09-3,06; p = 0,02). CONCLUSÕES: O tratamento cirúrgico das metástases pulmonares oriundas de diferentes sítios tumorais é efetivo e seguro, com boa sobrevida global, especialmente nos casos com um menor número de lesões ...

Descriptive analysis of and overall survival after surgical treatment of lung metastases.

OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.

A influência do uso do "clamp" ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares / The influence of clamp usage on clot deposit formation inside thoracic drains

OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influência do uso da braçadeira sobre o acúmulo de coágulos dentro dos drenos pleurais. MÉTODO: Os drenos pleurais foram pesados logo após sua retirada, lavados e secados e pesados novamente. A diferença entre a primeira e a segunda pesagem foi admitida como a quantidade de coágulos acumulada. RESULTADOS: Houve maior acúmulo de coágulo nos drenos temporariamente obstruídos por braçadeira em relação àqueles não obstruídos. CONCLUSÃO: Notou-se, neste estudo, maior acúmulo de coágulo dentro de drenos pleurais obstruídos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussão sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educação continuada para médicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.

BACKGROUND: A prospective study was done to evaluate the influence of clamp usage on clot formation inside thoracic drains. METHODS: Each drain was weighed soon after removal; they were then washed, dried and weighed again. The difference between the first and second weights was taken as the amount of clot deposit formed. RESULTS: We found more clots accumulated inside the drains that were temporarily obstructed by the clamp. CONCLUSION: In this study, there were more clots formation inside thoracic drains clamped, even if they were occluded intermittently. This can lead thoracic drains to function improperly. The discussion about the correct usage of thoracic drains must be a subject for educational programs for physicians and nurses, to aim for the safest use of this widely used and highly efficient system.

Fístula linfática após esofagectomia: o que fazer? / Lymphatic fistula after esophagectomy: what to do?

RACIONAL: As lesões do ducto torácico ocasionando quilotórax são pouco freqüentes e ocorrem durante procedimentos torácicos e traumas, tais como esofagectomias, procedimentos cirúrgicos mediastinais e pleuro-pulmonares. A operação está indicada se não houver resolução espontânea. OBJETIVO: Analisar a fístula linfática como complicação de esofagectomias para doenças malignas e benignas. MÉTODOS: Sete doentes com idade média de 42 anos, sendo cinco masculinos, apresentaram quilotórax no pós-operatório de esofagectomias realizadas para o carcinoma epidermóide (cinco casos) e megaesôfago chagásico avançado (dois casos). A nutrição parenteral total foi indicada em todos os pacientes. RESULTADOS: A drenagem média foi de 2700 mL/dia, e a pleurodese foi o primeiro procedimento preconizado, com resultados pouco satisfatórios. Procedimento cirúrgico foi indicado na persistência da fístula. Três doentes foram submetidos à videotoracoscopia direita e em um deles houve necessidade de reintervenção por toracotomia direita. No outro caso, houve necessidade de conversão imediata para toracotomia direita. E no último, por meio da videotoracoscopia, o ducto torácico foi identificado e ligado. Os demais casos foram submetidos à toracotomia direita. A evolução pós-operatória foi favorável para os seis doentes operados, que receberam alta hospitalar após período médio de internação de 36 dias. Um doente com carcinoma faleceu (15%) por complicações decorrentes de cirrose hepática. CONCLUSÕES: A fístula linfática pós-esofagectomia é complicação grave, que determina déficit nutricional significativo e exige com freqüência tratamento operatório para ligadura do ducto, sendo a videotoracoscopia a primeira escolha.

BACKGROUND: Lesions of the thoracic duct causing chylotorax are less frequent and normally happen during thoracic procedures and traumas, such as esophagectomies, mediastinal and pleuro-pulmonary surgeries. Therefore, surgery is suitable if there is no spontaneous resolution. AIM: To analyze the lymphatic fistula as a complication of esophagectomy regarding malignant and benign diseases. METHODS: Seven patients with an average age of 42 years, being five males, presented postoperative chylotorax after esophagectomies accomplished for the epidermoid carcinoma (five cases) and advanced chagasic megaesophagus (two cases). Total parenteral nutrition was indicated in all cases. RESULTS: The average drainage was of 2700 mL/day, and pleurodesis was the first procedure made, with minimal satisfactory results. Surgery was indicated with the persistence of the fistula. Three patients were submitted to right videothoracoscopy and one of these was reoperated by right thoracotomy. Another case had the need of immediate conversion to right thoracotomy. And in the last case, the thoracic duct was identified and joined by means of videothoracoscopy. The rest of the cases were submitted to right thoracotomy. Post-operative evolution was favorable for six of the operated patients, who received hospital discharge after an average period of 36 hospitalization days. One patient who had carcinoma passed away (15%) due to hepatic cirrhosis complications. CONCLUSION: Post-esophagectomy lymphatic fistulas are dangerous complications, which determines the significant nutritional deficit of the patients and demands frequent surgical treatment for the joining of ducts, being videothoracoscopy one of the first choice procedures.

A importância dos exames subsidiários na avaliaçäo pré-operatória em hospital comunitário: análise de 1.500 pacientes / The role of the subsidiary laboratory tests in preoperative evaluation at a community hospital: analysis of 1.500 pacientes

Foram analisados 1.500 pacientes cirúrgicos tratados em hospital comunitário (1.700 procedimentos). Foi avaliada a distribuiçäo da casuística pelos fatores sexo, idade, porte cirúrgico, classificaçäo de estado físico, cirurgias realizadas, doenças associadas, anestesia empregada e exames subsidiários solicitados. Estes dados foram confrontados com a incidência de complicaçöes intra e pós-operatórias. Estudada igualmente a ocorrência de complicaçöes nos casos da näo realizaçäo dos exames subsidiários analisados. Os resultados näo foram significativos na avaliaçäo de: hemoglobina (p=0,8752), glicemia(p=0,7110), uréia(p=0,2228), hematócrito(p=0,2139), creatinina(p=0,9412), análise urinária(p=0,5144), raio x de tórax(p=0,2941) e porte cirúrgico(p=0,7231). Foram significativos em eletrocardiograma de pacientes masculinos(p=0,00395). As conclusöes finais foram qua a realizaçäo rotineira de exames pré-operatórios em hospital comunitário näo apresentou correspondente melhora nos resultados obtidos e näo incrementou a capacidade de prediçäo de complicaçöes. Infere-se que a solicitaçäo de cada um deles especificamente deve basear-se exclusivamente em critérios originários de adequada avaliaçäo clínica prévia

Blastoma pulmonar: relato de um caso / Pulmonary blastoma: case report

Os autores fazem o relato de um caso e revisäo da literatura acerca do blastoma pulmonar, neoplasia de ocorrência bastante rara e de histogênese discutida