Agnaldo Lopes da Silva Filho

Immunohistochemical WWOX Expression and Association with Angiogenesis, p53 Expression, Cell Proliferation and Clinicopathological Parameters in Cervical Cancer

OBJECTIVE  The current study evaluated the expression of WW domain-containing oxidoreductase (WWOX), its association with clinicopathological features and with p53, Ki-67 (cell proliferation) and CD31 (angiogenesis) expression in patients with invasive cervical squamous cell carcinoma (ICSCC). To the best of our knowledge, no other study has evaluated this association. METHODS  Women with IB stage-ICSCC (n = 20) and women with uterine leiomyoma (n = 20) were prospectively evaluated. Patients with ICSCC were submitted to type B-C1 radical hysterectomy and pelvic lymphadenectomy. Patients in the control group underwent vaginal hysterectomy. Tissue samples were stained with hematoxylin and eosin for histological evaluation and protein expression was detected by immunohistochemistry studies. RESULTS  The WWOX expression was significantly lower in the tumor compared with the expression in the benign cervix (p = 0.019). The WWOX expression was inversely associated with the CD31 expression in the tumor samples (p = 0.018). There was no association between the WWOX expression with the p53 expression (p = 0.464) or the Ki-67 expression (p = 0.360) in the samples of invasive carcinoma of the cervix. There was no association between the WWOX expression and tumor size (p = 0.156), grade of differentiation (p = 0.914), presence of lymphatic vascular invasion (p = 0.155), parametrium involvement (p = 0.421) or pelvic lymph node metastasis (p = 0.310) in ICSCC tissue samples. CONCLUSION  The results suggested that WWOX may be involved in ICSCC carcinogenesis, and this marker was associated with tumor angiogenesis.

Repercussões hemodinâmicas do posicionamento em litotomia exagerada para histerectomia vaginal em paciente cardiopata: relato de caso

JUSTIFICATIVA E OBJETIVOS: A tecnica de histerectomia vaginal possibilita menor tempo operatorio e o uso do bloqueio do neuro-eixo, com os beneficios de melhor analgesia pos-operatoria e menor resposta sistemica ao procedimento cirurgico. O objetivo deste relato foi descrever as alteracoes hemodinâmicas decorrentes do posicionamento em litotomia exagerada em paciente cardiopata. RELATO DO CASO: Paciente de 33 anos, G0P0A0, com historia de sangramento uterino anormal e anemia. A ultra-sonografia evidenciava utero miomatoso com volume estimado de 420 cm3. Ela era portadora de trombofilia e miocardiopatia dilatada, com passado de dois acidentes vasculares encefalicos isquemicos e dois infartos agudos do miocardio. Foi monitorizada com pressao arterial invasiva e cateter de arteria pulmonar com medida de debito cardiaco continuo. Realizada raquianestesia com bupivacaina hiperbarica e morfina. A paciente foi posicionada em litotomia exagerada sendo realizada histerectomia total pela tecnica de Heaney e salpingectomia bilateral. Como intercorrencia intra-operatoria apresentou diminuicao do indice cardiaco e aumento das pressoes de câmaras direitas apos o posicionamento, necessitando do uso de dobutamina. CONCLUSOES: O posicionamento em litotomia exagerada pode ocasionar alteracoes hemodinâmicas que devem ser consideradas na escolha da tecnica cirurgica.BACKGROUND AND OBJECTIVES Vaginal hysterectomy shortens surgery duration and may be performed with neuraxial block, which promotes better postoperative analgesia and lower systemic response to surgical procedure. This report aimed at describing hemodynamic changes promoted by exaggerated lithotomy position in cardiac patient. CASE REPORT Female patient, 33 years old, with history of abnormal uterine bleeding and anemia. Ultrasound revealed myomas of approximately 420 cm(3). Patient had thrombophilia and dilated cardiomyopathy, with history of two ischemic strokes and two acute myocardial infarction. Monitoring consisted of invasive blood pressure and pulmonary artery catheter for continuous cardiac output measurement. Spinal anesthesia was performed with hyperbaric bupivacaine and morphine. Patient was placed in exaggerated lithotomy position being total hysterectomy performed by the Heaney technique and bilateral salpingectomy. Intraoperative intercurrences were post-positioning decreased cardiac output and increased right chambers pressure requiring dobutamine. CONCLUSIONS Exaggerated lithotomy position may promote hemodynamic changes which should be considered when choosing the surgical technique.

[Hemodynamic repercussions of exaggerated lithotomy position for vaginal hysterectomy in cardiac patient: case report.].

JUSTIFICATIVA E OBJETIVOS: A tecnica de histerectomia vaginal possibilita menor tempo operatorio e o uso do bloqueio do neuro-eixo, com os beneficios de melhor analgesia pos-operatoria e menor resposta sistemica ao procedimento cirurgico. O objetivo deste relato foi descrever as alteracoes hemodinâmicas decorrentes do posicionamento em litotomia exagerada em paciente cardiopata. RELATO DO CASO: Paciente de 33 anos, G0P0A0, com historia de sangramento uterino anormal e anemia. A ultra-sonografia evidenciava utero miomatoso com volume estimado de 420 cm3. Ela era portadora de trombofilia e miocardiopatia dilatada, com passado de dois acidentes vasculares encefalicos isquemicos e dois infartos agudos do miocardio. Foi monitorizada com pressao arterial invasiva e cateter de arteria pulmonar com medida de debito cardiaco continuo. Realizada raquianestesia com bupivacaina hiperbarica e morfina. A paciente foi posicionada em litotomia exagerada sendo realizada histerectomia total pela tecnica de Heaney e salpingectomia bilateral. Como intercorrencia intra-operatoria apresentou diminuicao do indice cardiaco e aumento das pressoes de câmaras direitas apos o posicionamento, necessitando do uso de dobutamina. CONCLUSOES: O posicionamento em litotomia exagerada pode ocasionar alteracoes hemodinâmicas que devem ser consideradas na escolha da tecnica cirurgica.BACKGROUND AND OBJECTIVES Vaginal hysterectomy shortens surgery duration and may be performed with neuraxial block, which promotes better postoperative analgesia and lower systemic response to surgical procedure. This report aimed at describing hemodynamic changes promoted by exaggerated lithotomy position in cardiac patient. CASE REPORT Female patient, 33 years old, with history of abnormal uterine bleeding and anemia. Ultrasound revealed myomas of approximately 420 cm(3). Patient had thrombophilia and dilated cardiomyopathy, with history of two ischemic strokes and two acute myocardial infarction. Monitoring consisted of invasive blood pressure and pulmonary artery catheter for continuous cardiac output measurement. Spinal anesthesia was performed with hyperbaric bupivacaine and morphine. Patient was placed in exaggerated lithotomy position being total hysterectomy performed by the Heaney technique and bilateral salpingectomy. Intraoperative intercurrences were post-positioning decreased cardiac output and increased right chambers pressure requiring dobutamine. CONCLUSIONS Exaggerated lithotomy position may promote hemodynamic changes which should be considered when choosing the surgical technique.

Repercusiones hemodinámicas de la posición de litotomía exagerada para histerectomía vaginal en una paciente con cardiopatía: relato del caso

JUSTIFICATIVA E OBJETIVOS: A tecnica de histerectomia vaginal possibilita menor tempo operatorio e o uso do bloqueio do neuro-eixo, com os beneficios de melhor analgesia pos-operatoria e menor resposta sistemica ao procedimento cirurgico. O objetivo deste relato foi descrever as alteracoes hemodinâmicas decorrentes do posicionamento em litotomia exagerada em paciente cardiopata. RELATO DO CASO: Paciente de 33 anos, G0P0A0, com historia de sangramento uterino anormal e anemia. A ultra-sonografia evidenciava utero miomatoso com volume estimado de 420 cm3. Ela era portadora de trombofilia e miocardiopatia dilatada, com passado de dois acidentes vasculares encefalicos isquemicos e dois infartos agudos do miocardio. Foi monitorizada com pressao arterial invasiva e cateter de arteria pulmonar com medida de debito cardiaco continuo. Realizada raquianestesia com bupivacaina hiperbarica e morfina. A paciente foi posicionada em litotomia exagerada sendo realizada histerectomia total pela tecnica de Heaney e salpingectomia bilateral. Como intercorrencia intra-operatoria apresentou diminuicao do indice cardiaco e aumento das pressoes de câmaras direitas apos o posicionamento, necessitando do uso de dobutamina. CONCLUSOES: O posicionamento em litotomia exagerada pode ocasionar alteracoes hemodinâmicas que devem ser consideradas na escolha da tecnica cirurgica.BACKGROUND AND OBJECTIVES Vaginal hysterectomy shortens surgery duration and may be performed with neuraxial block, which promotes better postoperative analgesia and lower systemic response to surgical procedure. This report aimed at describing hemodynamic changes promoted by exaggerated lithotomy position in cardiac patient. CASE REPORT Female patient, 33 years old, with history of abnormal uterine bleeding and anemia. Ultrasound revealed myomas of approximately 420 cm(3). Patient had thrombophilia and dilated cardiomyopathy, with history of two ischemic strokes and two acute myocardial infarction. Monitoring consisted of invasive blood pressure and pulmonary artery catheter for continuous cardiac output measurement. Spinal anesthesia was performed with hyperbaric bupivacaine and morphine. Patient was placed in exaggerated lithotomy position being total hysterectomy performed by the Heaney technique and bilateral salpingectomy. Intraoperative intercurrences were post-positioning decreased cardiac output and increased right chambers pressure requiring dobutamine. CONCLUSIONS Exaggerated lithotomy position may promote hemodynamic changes which should be considered when choosing the surgical technique.