Ovarian Germ Cell Cancer: Clinicopathologic Analysis and Outcome of 31 Cases

Aims

The aim of the study was to evaluate some clinicopathologic characteristics and the outcome of patients with ovarian germ cell cancer (OGCC) treated with cisplatin-based chemotherapy.

Methods

It was a clinical retrospective study. The clinical charts of 31 patients with OGCC assisted at the Department of Obstetrics and Gynecology of the State University of Campinas, Brazil, from January 1986 to June 1997 were reviewed.

Results

Ten patients had dysgerminoma and 21 patients nondysgerminomatous tumors. Women with dysgerminoma and nondysgerminomatous tumors did not present differences regarding surgical staging, age, ascites or residual tumor after the initial surgery. Frozen section, performed in 16 patients, showed some discrepancy with paraffin histology diagnosis in 8 patients. Platinum-based chemotherapy was used in 5/10 patients with dysgerminoma and in 17/21 patients with nondysgerminomatous tumors, with a 5-year survival of 100% for the dysgerminoma and 53% for the nondysgerminomatous group.

Conclusions

Women with dysgerminoma and nondysgerminomatous tumors did not present differences regarding clinicopathologic characteristics. The prognosis for patients with dysgerminoma was better than for those with nondysgerminomatous tumors. Frozen section had a high error rate in diagnosing OGCC intraoperatively.

Association between Immunohistochemical Expression of Topoisomerase IIα, Her2 and Hormone Receptors and Response to Primary Chemotherapy in Breast Cancer

The aim of this study was to evaluate the association between immunohistochemical expression of topoisomerase IIα, HER2 and hormone receptors and response to primary anthracycline-based chemotherapy in locally advanced breast cancer. We analyzed 109 medical charts of patients treated with primary anthracycline-based chemotherapy in the Women's Integral Health Care Center from 1996 to 2004. The clinical and pathological response to primary chemotherapy was associated with topoisomerase IIα and HER2 expression and hormone receptor negativity. Statistical analysis was performed using chi-squared, Fisher's exact test and Mann-Whitney test. No statistical association between clinical response and expression of topoisomerase IIa, HER2 and hormone receptor negativity was found. However, there was an association between complete pathological response and hormone receptor negativity (P = 0.0289). The present study suggested that these markers should not be considered predictors of response to primary anthracycline-based chemotherapy, and prospective studies must be designed for this purpose.

Concomitant cisplatin plus radiotherapy and high-dose-rate brachytherapy versus radiotherapy alone for stage IIIB epidermoid cervical cancer: a randomized controlled trial

PURPOSE

The benefits of chemoradiotherapy (CRT) for cervical cancer compared with radiation (RT) alone seem to diminish in later-stage disease. However, these modalities have not been directly compared for disease-free interval (DFI) and overall survival (OS) of women with stage IIIB cervical cancer.

PATIENTS AND METHODS

We conducted a randomized controlled clinical trial comparing DFI and OS of 147 women with stage IIIB squamous cervical cancer who received either cisplatin plus RT (CRT) or RT alone (72 patients in the CRT group and 75 patients in the RT-only group).

RESULTS

The CRT group had significantly better DFI (hazard ratio [HR], 0.52; 95% CI, 0.29 to 0.93; P = .02). However, patients in the CRT group did not have significantly better OS than those in the RT-only group (HR, 0.67; 95% CI, 0.38 to 1.17; P = .16). Toxicity was graded according to criteria of the Radiation Therapy Oncology Group. The organs affected (excluding hematologic effects) did not differ significantly between groups. Also, late toxicity events and organs affected were not significantly disproportionate between the study groups.

CONCLUSION

For stage IIIB cervical cancer, the addition of cisplatin offers a small but significant benefit in DFI, with acceptable toxicity.

Predictive factors for winged scapula in breast cancer patients after immediate axillary dissection

e20634

Background: Axillary lymph node dissection is an inevitable part of breast cancer surgery in certain cases. Definitive data regarding the incidence of postoperative winged scapula remains inconsistent. Ignorance of its diagnosis may lead to under-treatment and result in physical morbidity. Methods: All breast cancer patients who underwent axillary lymph node dissection procedures were recruited. In the early postoperative period, within 24 hours after surgery, the physiotherapy staff performed physical examinations to evaluate and identify the physical signs of long thoracic nerve injury by means of two specific orthopedic evaluation tests. The factors that may relate to winged scapula were recorded and analyzed. Results: From July to October 2012, 51 out of 187 patients were diagnosed with winged scapula (27.2%). The median age was 49.0 years old. 130 patients had undergone mastectomy and 100 cases had immediate breast reconstruction. Age, BMI, history of shoulder joint morbidity and previous breast surgery were not significantly associated with winged scapula. Administration of neoadjuvant treatment, mastectomy or breast conservative surgery, immediate reconstruction and its type, tumor size and nodal involvement also did not show any correlation. Conclusions: The winged scapula is not an infrequent sequela after axillary lymph node dissection in the breast cancer patient. It is usually underestimated and overlooked. There is no association between age, BMI, neoadjuvant treatment, type of breast surgery, tumor size or nodal stage. As breast reconstruction plats an ever-increasing role in current breast surgery practice it is interesting to note that reconstruction with prosthesis, even with serratus muscle dissection does not increase the incidence of winged scapula. Post reconstruction morbidity could interfere with the physical evaluation and outcome, but the result of our subgroup analysis showed no significant correlation among them. In our clinical experience, this sequela is not irreversible, being a transitory problem. Our series show only immediate 24 hr result that lack of long term follow-up and still need physical therapy proctocols to evaluate the recovery.

HER2 expression in Brazilian patients with estrogen and progesterone receptor-negative breast carcinoma

The aim of the study was to evaluate the relationship between clinical and pathological factors and survival in patients with double negative HER2-overexpressing carcinoma and triple negative carcinoma. One hundred and sixty-one (161) patients diagnosed with breast cancer negative for estrogen receptor (ER) and progesterone receptor (PR) were included. Of the total, 58 patients had double negative HER2-overexpressing (ER/PR-negative and HER2-positive) and 103 had triple negative (ER-negative, PR-negative and HER2-negative). ER and PR expression was assessed through immunohistochemistry (IHC) and HER2 expression was measured by immunohistochemistry and Fluorescent in situ Hybridization (FISH) analysis in tissue microarray. More than 80% had stages II and III disease and histologic grade III and nuclear grade 3. Patients with triple negative breast carcinoma had undifferentiated histologic types in 11% of cases and vascular invasion in 14.5%. Both groups had more than 50% visceral metastases. HER2 expression (p=0.42) and vascular invasion (p=0.05) did not interfere with survival. Survival of patients with Stages I-II disease was significantly longer than in those with Stage III disease both for double negative HER2-overexpressing carcinomas (p<0.0001) and triple negative carcinomas (p=0.03). The study shows that hormone receptor-negative breast carcinomas were undifferentiated and diagnosed at advanced stages and that HER2 expression was not associated with overall survival.

Abordagem do trauma renal - artigo de revisão: review of the literature

A incidência de traumatismo é uma realidade crescente nos dias de hoje. O acometimento dos reina ocorre em cerca de 10% dos pacientes com trauma abdominal fechado ou penetrante, podendo elevar muito a morbimortalidade quando não bem conduzido. Os autores fizeram um levantamento de artigos recentes para esclarecimentos no diagnóstico e na conduta no traumatismo renal, desde os detalhes anatômicos até o tratamento definitivo. A correta condução do paciente é fundamental para a preservação e manutenção da função do órgão, sobretudo da vida, após o evento traumático.

Randomized clinical trial on the preservation of the medial pectoral nerve following mastectomy due to breast cancer: impact on upper limb rehabilitation

CONTEXT AND OBJECTIVE

Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the pectoral nerves and their effects. The aim of this study was to compare muscle strength and mass of the pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the medial pectoral nerve (MPN).

DESIGN AND SETTING

Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil.

METHODS

The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fisher's exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance.

RESULTS

In the MPN preserved group, 81% of the women did not lose any PMM strength, compared with 31% in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8).

CONCLUSIONS

Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups.

CLINICAL TRIAL REGISTRATION NUMBER

ANZCTR - 00082622.

Association between immunohistochemical expression of topoisomerase IIalpha, HER2 and hormone receptors and response to primary chemotherapy in breast cancer

The aim of this study was to evaluate the association between immunohistochemical expression of topoisomerase IIalpha, HER2 and hormone receptors and response to primary anthracycline-based chemotherapy in locally advanced breast cancer. We analyzed 109 medical charts of patients treated with primary anthracycline-based chemotherapy in the Women's Integral Health Care Center from 1996 to 2004. The clinical and pathological response to primary chemotherapy was associated with topoisomerase Ilalpha and HER2 expression and hormone receptor negativity. Statistical analysis was performed using chi-squared, Fisher's exact test and Mann-Whitney test. No statistical association between clinical response and expression of topoisomerase Ilalpha, HER2 and hormone receptor negativity was found. However, there was an association between complete pathological response and hormone receptor negativity (P = 0.0289). The present study suggested that these markers should not be considered predictors of response to primary anthracycline-based chemotherapy, and prospective studies must be designed for this purpose.

Responses of Holstein Cows to a Low Dose of Somatotropin (bST) Prepartum and Postpartum

Objectives were to evaluate the effects of a low dose of bovine somatotropin (bST) injected prepartum and postpartum on body condition score (BCS), body weight (BW), and milk yield (MY) in cows as well as somatotropin insulin, insulin-like growth factor-I (IGF-I), glucose, and nonesterified fatty acids (NEFA) in plasma. Holstein cows nearing second or later parities were assigned randomly to control (CON = 98) or bST-treated (TRT = 95) groups. Biweekly injections of bST began 21 +/- 3 d before expected calving and continued through 42 d postpartum (CON vs. TRT; 0 vs. 10.2 mg of bST/ d). From 42 to 100 d postpartum, no cows received bST. During yr 1, somatotropin, IGF-I, insulin, NEFA, and glucose were measured in plasma samples from 82 cows. During yr 2, effects of bST on BCS and BW of 111 cows were evaluated, but no blood samples were collected. Milk yields through 100 d of all 193 cows were analyzed. Prepartum treatment with bST resulted in greater prepartum plasma concentrations of somatotropin, insulin, and numerically greater NEFA but did not affect glucose or IGF-I. Postpartum bST increased mean plasma concentrations of somatotropin and NEFA, but not INS, IGF-I, or glucose. Mean BCS of cows did not differ prepartum, around parturition, or postpartum. Although mean BW did not differ prepartum or around calving, cows receiving bST maintained greater BW postpartum. Cows receiving bST tended to have higher MY (6.6%) in the first 60 d of lactation, but differences did not persist through 100 d, including approximately 40 d when no cows received bST. Number of cows that were culled due to health (CON = 3 vs. TRT = 2) or died (CON = 3 vs. TRT = 1) were not affected by treatment. Low doses of bST in the transition period resulted in higher postpartum BW, quicker recovery of body condition during lactation, and significantly more milk during treatment.

Breast cancer metastatic to uterine leiomyosarcoma. A case report and review of the literature

An unusual case of breast cancer metastatic to leiomyosarcoma of the uterus is reported. The patient had multiple metastases from the breast carcinoma and presented a pelvic mass in its evolution. A laparotomy with total hysterectomy and bilateral oophorectomy was performed to give pain relief. A review of the world literature about these uncommon sites of breast metastases is presented.

Simultaneous saccharification and cofermentation of peracetic acid-pretreated biomass

Previous work in our laboratories has demonstrated the effectiveness of peracetic acid for improving enzymatic digestibility of lignocellulosic materials. The use of dilute alkali solutions as a pre-pretreatment prior to peracetic acid lignin oxidation increased carbohydrate hydrolysis yields in a synergistic as opposed to additive manner. Deacetylation of xylan is easily achieved using dilute alkali solutions under mild conditions. In this article, we evaluate the effectiveness of peracetic acid combined with an alkaline pre-pretreatment through simultaneous saccharification and cofermentation (SSCF) of pretreated hybrid poplar wood and sugar cane bagasse. Respective ethanol yields of 92.8 and 91.9% of theoretical are achieved using 6% NaOH/15% peracetic acid-pretreated substrates and recombinant Zymomonas mobilis CP4/pZB5. Reduction of acetyl groups of the lignocellulosic materials is demonstrated following alkaline pre-pretreatments. Such processing may be helpful in reducing peracetic acid requirements. The influence of deacetylation is more significant in combined pretreatments using lower peracetic acid loadings.

Primary melanoma of the uterine cervix figo stage III B

The primary malignant melanoma of the uterine cervix is rare, usually diagnosed at an advanced stage and with poor prognosis. The diagnosis is made through histological evaluation and confirmed by special staining procedures. Radical surgery has been used and advocated. However in its advanced stages chemotherapy, immunotherapy or radiotherapy can be employed. A case of a patient with malignant melanoma of the uterine cervix, Stage IIIb, is presented in addition to a clinical and pathological discussion.

Clinical evaluation of gallium alloy as a posterior restorative material

This study evaluated 30 gallium alloy (Gallium alloy GF) and 31 amalgam (Dispersalloy) restorations over a period of 8 months in both Class I and Class II cavity preparations in 28 human subjects. At baseline, all gallium alloy and amalgam restorations were considered acceptable (Alfa) in terms of caries, anatomic form, marginal adaptation, surface texture, and bulk fracture. Postoperative sensitivity was reported in 67% of the gallium alloy restorations and in 29% of the amalgam restorations. At 8 months, 61% of the gallium alloy restorations were rated Beta for marginal adaptation, and all restorations exhibited tarnish and corrosion. With a few exceptions, the amalgam restorations were rated Alfa for those criteria. Three gallium alloy restorations had to be replaced during the evaluation period because of severe postoperative sensitivity and 39% of gallium restorations still presented some sensitivity at 8 months. Additional problems exhibited by gallium restorations were tooth fractures, tooth cracks, and marginal whitening.

Clinical microleakage evaluation of a cavity varnish

This clinical study evaluated the microleakage effectiveness of a cavity varnish when used in combination with two types of amalgam: a spherical particle and a dispersed phase alloy. Calcium hydroxide was utilized as the microleakage detection agent. Copalite showed a reduction in microleakage when it was employed with the spherical particle alloy used in this study. This study clinically demonstrated that Copalite is not totally effective in eliminating microleakage.

Situation of radiotherapy in Latin America

A survey to evaluate situation of radiotherapy in Latin America was conducted. Consultation was made with representatives of 10 countries, resulting in the responses of 5. These five countries represent around 80% and 81%, respectively, from the total area and population of South America. Situation of equipment, modern facilities, and human resources is analyzed. A Cobalt machine is the basic megavoltage equipment in Latin America; half of the total number, however, is of old units with very low output sources. Linacs represent one-third of cobalt machines, the majority of low photon energy without electron capability. Treatment planning, localization, patient positioning, and immobilization are inadequade or of low quality in a high number of institutions. Teaching programs are insufficient or inexistent in certain areas. Late diagnosis and referral for treatment is a major problem for cancer control in Latin America. Hierarchization and regionalization of radiation therapy centers are indicated as a way to provide high quality services and teaching programs. In Latin America, lodging and facilities for transportation are essential to assure the continuity of radiation treatment and regular follow-up to patients from rural or distant areas.

Clinical evaluation of a posterior composite resin containing a semiporous filler particle

Bowen recently developed a new filler particle for composite resin restorations. The surface particles of a diphasic strontium glass are superficially etched and after silanating the surface, the microscopic defects are filled with prepolymerized resin. The filler particles are then bonded chemically and mechanically to the resin matrix. This paper discusses the clinical performance of this material as a posterior composite resin over a two year period.

Estrogen receptors in breast cancer--therapeutic response to the treatment of recurrences

The authors analyze estrogen receptors in 501 cases of breast cancer and the therapeutic response achieved with treatment of patients who relapsed. The method utilized to determine the presence of estrogen receptor was cytosol protein-counting and Dextran coated charcoal (DCC) saturation analysis. Patients were treated with chemotherapy when the primary tumor was estrogen-receptor negative. If receptor was present, anti-estrogen drug (Tamoxifen) was added. Patients previously treated with the anti-estrogen presented a better response to anti-estrogen therapy and a lower recurrence rate. Recurrences were more frequent in estrogen receptor negative cases and better responses to treatment were found in estrogen receptor positive ones.

Wear rates of posterior composite resins

The wear rates of nine posterior composite resins were determined for a period of up to 3 years. The wear rates observed depended on the method used for evaluation. A quantitative method of evaluation showed that the wear rates decreased with time. With the use of the quantitative measurements obtained at the end of 6 months after insertion, it was possible to predict the average annual rates of wear at the end of 3 years.

[Neurocutaneous melanosis: autopsy study of a case]

The clinical, radiological and autopsy features of a 5-month-old child with neurocutaneous melanosis are described. The patient had multiple disseminated benign cutaneous nevi. The pneumoencephalogram showed non-obstructive hydrocephalus. The patient died at the third day of hospitalization and autopsy was performed. A mild hydrocephalus and melanic specks in cerebellum and in the brainstem were disclosed.

The acid-etch class III composite resin restoration

The acid-etch systems have become a familiar part of the dentist's armamentarium for achieving retention in the treatment of major esthetic problems in anterior teeth. They have another advantage, however, that has not been fully utilized. By combining the acid-etch technique with conventional cavity preparations such as the Class III, the common problems associated with microleakage can be greatly reduced and composite resin restorations can be placed with better esthetic results and greater longevity.

[Bilateral cerebral mycotic aneurysm in a child. Report of a case and review of the literature]

The case of a 6 year-old boy, who was hospitalized with the diagnosis of purlent meningits is reported. The CSF examination disclosed pleocytosis and the antibioticotherapy was instituded. The bilateral carotid angiography demonstrated an arterial aneurysm of the frontal ascendent artery with hematoma in the left side and another in the posterior temporal artery, in the right side. The patient was operated on because of the hematoma, in the left side. The condition of the patient in the post-operatory period deteriorated and the death ocurred. The post-mortem examination disclosed a sub-arachnoidal hemorrhage, fronto-temporal hematoma in the left side and a para-capsular hematoma in the right side. The histological examination of the central part of the right side. The histological examination of the central part of the hematoma revealed a dilated arterial walls with a supurative inflammatory process.

Neurocitoma no sistema nervoso central

É relatado o caso de uma paciente com 6 anos de idade, hospitalizada com síndrome de hipertensão intracraniana. Após o exame neuro-radiológico que evidenciou processo expansivo frontal direito, a paciente foi submetida à cirurgia, durante a qual ocorreu o óbito. O exame histo-patológico do material retirado durante o ato operatório, permitiu o diagnóstico de neurocitoma, tumor raro no sistema nervoso central.

Tuberculomas cerebrais múltiplos em lactente

É relatado um caso de uma menina com 11 meses de idade, apresentando distrofia de III.º grau, desidratação e processo pleuro-pulmonar grave. Após a hospitalização ocorreu paralisia facial periférica à direita, progredindo e quadro neurológico para paralisia de ambos os nervos motores oculares externos, do pneumogástrico e do glossofaríngeo. Após evolução rápida para o coma, ocorreu o óbito, tendo a autópsia mostrado tuberculose pulmonar, mesentérica e cerebral. O caso é discutido quanto à idade da paciente, à multiplicidade e localização dos tuberculomas encefálicos, ao quadro clínico apresentado, ao encontro de bacilos de Koch nos tuberculomas intracranianos e à normalidade do líquido cefalorraqueano.