Carlos Augusto Real Martinez

Identification of prognostic factors predicting outcome in Hodgkin's lymphoma patients relapsing after autologous stem cell transplantation

BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for patients with relapsed Hodgkins lymphoma (HL). However, there is currently little information on the predictors of outcome for patients whose disease recurs after ASCT. METHODS Five hundred and eleven adult patients with relapsed HL after ASCT from EBMT-GITMO databases were reviewed. RESULTS Treatments administered following ASCT failure included conventional chemotherapy and/or radiotherapy in 294 (64%) patients, second ASCT in 35 (8%), and alloSCT in 133 (29%). After a median follow-up of 49 months, overall survival (OS) was 32% at 5 years. Independent risk factors for OS were early relapse (<6 months) after ASCT, stage IV, bulky disease, poor performance status (PS), and age ≥50 years at relapse. For patients with no risk factors OS at 5 years was 62% compared with 37% and 12% for those having 1 and ≥2 factors, respectively. This score was also predictive for outcome in each group of rescue treatment after ASCT failure. CONCLUSION(S) Early relapse, stage IV, bulky disease, poor PS, and age ≥50 years at ASCT failure are relevant factors for outcome that may help to understand the results of different therapeutic approaches.

Analysis of Oxidative DNA Damage in Patients with Colorectal Cancer

PURPOSE The aim of this study was to measure the levels of oxidative DNA damage in cells isolated from the colon mucosa in patients with colorectal cancer and to compare normal and neoplastic tissues and make correlations with anatomopathologic variables. PATIENTS AND METHODS Thirty-three patients with colorectal adenocarcinoma were studied. The oxidative DNA damage was evaluated by means of the alkaline version of the comet assay. RESULTS For all the patients studied, it was found that the cells obtained from the neoplastic tissue presented oxidative DNA damage greater than in the cells from normal tissue. The cells isolated from the neoplastic mucosal tissue of the colon presented significantly greater mean extent of DNA strand breakage than the cells isolated from normal tissue. Additionally, the patients at earlier stages of the Dukes and TNM classifications presented higher levels of oxidative damage than those at more advanced stages. CONCLUSION Assessment of the levels of oxidative damage at the different stages of colorectal carcinogenesis is of great interest because it enables evaluation of the effectiveness of antioxidant substances that could be used as preventive measures against the initial oxidative aggressive action on the colonic mucosa.

Giant retroperitoneal lipoma: a case report

BACKGROUND Retroperitoneal lipoma is an extremely rare neoplasm. AIMS The authors report a case of giant retroperitoneal lipoma in a 32-year-old white female, with a history of pain and an abdominal mass over a 2-year period. Total abdominal ultrasonography and barium enema showed a large mass located in the retroperitoneal space behind the ascending colon. Laparotomy showed a large encapsulated tumor measuring 20 x 13 x 10 cm and weighing 3.400 g. The histological study revealed a benign neoplasm of fatty cells. CONCLUSION The patient remains well 17 years after surgery, without recurrence of the disease.

Soybean and fish oil mixture increases IL-10, protects against DNA damage and decreases colonic inflammation in rats with dextran sulfate sodium (DSS) colitis

It was investigated whether dietary polyunsaturated fatty acids (PUFA) could influence colonic injury, tissue DNA damage, cytokines and myeloperoxidase activity (MPO) and plasma corticosterone in DSS-induced colitis rats. Male weaning Wistar rats were fed for 47 days with an AIN-93 diet with control (C), fish (F) or a mixture of fish and soybean oil (SF). The colitis was induced from day 36 until day 42 by 3% DSS in drinking water. On day 48, blood samples were collected for corticosterone determination. The distal colon was excised for histological analysis and to quantify the cytokine (IL-4, IL-10 and INF-γ), MPO and DNA damage. The disease activity index (DAI) was recorded daily during colitis induction. The DAI, MPO, histological analyses showed decreases only in the SF group compared with the C group. IL-10 was increased and DNA damage was reduced in the groups F and SF, and an inverse correlation between these variables was found. There were no differences in corticosterone, IFN-γ and IL-4 levels. Soybean and fish oil mixture may be effective in improving colonic injury and DNA damage, and it could be an important complementary therapy in UC to reduce the use of anti-inflammatory drugs and prevent colorectal cancer.

Influência da irrigação de soluções nutricionais no colo excluso de trânsito intestinal: estudo experimental em ratos

Diversion colitis is described as an inflammatory process that occurs in the colorectal segments excluded of the fecal stream. The deficiency of the short-chain fatty acids inside of intestinal lumen was considered the main etiologic factor. AIM: The aim of the present study was valued, in experimental model of diversion colitis, the importance of the irrigation of the segment without fecal stream with nutritional solutions in prevention and treatment of the colic mucosa inflammation. METHOD: There were used thirty Wistar males rats, with initial weight varying between 350 and 500 grammas, submitted to the derivation of the fecal stream through proximal colostomy and distal mucous fistula. The animals were divided in three groups with 10 animals according to the irrigation of the excluded colic segment had been carried out with: SF Group: 0.9 % physiologic solution; GH Group: hypertonic glucose solution of 50 % and AG Group: solution of short-chain fatty acids. In all the animals, the irrigation of the excluded colon was carried each four days and the animals were sacrificed ever in 21st post-operative day. The removed fragments of the intestinal segments were colored by the techniques of hematoxylin-eosin and Masson trichromium. The histological variables studied were: thickness of the mucous layer, vascular congestion; inflammatory infiltrate and the level of tissue collagen. The considered results were subjected to statistical study considering signification level of 5 % (p <0.05). RESULTS: The obtained results showed that in the group where the excluded colon was irrigated with solution of short-chain fatty acids there was less vascular congestion, less inflammatory infiltrated and less collagen deposition when compared to another experimental groups. CONCLUSION: The results of the present study indicate that in the group receiving the short-chain fatty acid solution there was a decrease in the inflammatory infiltrate and the vascular congestion, as well as a reduction in the deposition of collagen tissue. The irrigation of segments without fecal stream with short-chain fatty acids it improves the inflammatory process found in the diversion colitis.

Avaliação dos níveis de peroxidação lipídica em células da mucosa cólica após aplicação de enemas com peróxido de hidrogênio: estudo experimental em ratos

The use of rectal enemas with hydrogen peroxide (H2O2) determines the onset of severe colitis, sometimes with fatal evolution. It is possible that H2O2-induced colitis can occur by damage to the functional epithelial barrier of the colon by oxidative stress. Objective: The aim of present study was evaluate the levels of lipid peroxidation in cells of the colonic mucosa after instillation of H2O2 into the rectum excluded from fecal transit. Method: Twenty six male Wistar rats were undergone to proximal terminal colostomy in the descending colon and distal mucous fistula. The animals were randomized in two experimental groups according to the sacrifice was made two or four weeks after diversion of the fecal stream. Each experimental group was divided into two subgroups second application of enemas containing saline solution 0.9% or 3% H2O2 on alternate days. The diagnosis of colitis was established by histopathology study and the oxidative damage by tissue levels of malondialdehyde quantified by spectrophotometry. The results were analyzed with the Mann-Whitney and Kruskal-Wallis test, adopting a significance level of 5% (p <0.05). Results: The levels of malondialdehyde in colon segments irrigated with saline, with and without fecal stream after two and four weeks of irrigation were: 0.05 ± 0.006, 0.06 ± 0.006 and 0.05 ± 0.03, 0.08 ± 0.02, respectively. The levels of malondialdehyde in colon segments irrigated with H2O2, in the colon with and without fecal stream, after two and four weeks of irrigation were 0.070 ± 0.006, 0.077 and 0.052 ± 0.01 ± 0.01, 0.08 ± 0.04, respectively . After two weeks the levels of malondialdehyde were higher on animals irrigated with H2O2 than control group (p = 0.007 and p = 0.01, respectively). After four weeks there were no significant differences in malondialdehyde levels related with the time of irrigation. Conclusion: Rectal enemas with H2O2, may determine the onset of colitis by oxidative stress on epithelial cells of intestinal mucosa.

Miíase vulvar: relato de caso

Myiasis located in the vulva is a rarely described disease. The objective of the present report is to describe a case of vulvar myiasis due to larvae of Cochliomyia hominivorax. A 77-year-old woman with precarious hygienic habits presented pain, pruritus and secretions with a fetid smell in the genital region for 10 days. Gynecological examination demonstrated an ulcerated lesion in the labium majus of the vulva measuring six centimeters that extended to the mons pubis and was found to be filled with larvae. The patient progressed favorably after removal of the larvae, surgical debridement and daily dressings. Fourteen days after the debridement, she was submitted to skin flap rotation, with good local scar formation. Two months after the intervention, she remained asymptomatic. Vulvar myiasis must be considered in the differential diagnosis of infectious diseases of the vulva in patients with precarious hygienic habits.

Gastric necrosis and perforation as a complication of splenectomy. Case report and related references

Necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patients clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.

Morphometric study of gastric mucosa in dogs submitted to proximal gastric vagotomy, splenectomy or proximal gastric vagotomy associated with splenectomy

OBJETIVO: Avaliar os efeitos da esplenectomia total e da vagotomia gastrica proximal (VGP) isoladas e associadas sobre a vascularizacao gastrica. METODOS: Utilizaram-se 28 caes, distribuidos em quatro grupos: grupo A, laparotomia e manipulacao gastrica; grupo B, VGP; grupo C, VGP associada a esplenectomia; grupo D, esplenectomia isolada. Todos os animais foram mortos no 7o pos-operatorio e imediatamente infundiu-se o corante na aorta toracica. O estomago aberto pela grande curvatura foi fotografado. Na superficie mucosa gastrica, a formacao de areas coradas e desprovidas de coloracao foi mensurada por tres metodos: decomposicao milimetrica, planimetrico e morfometria computadorizada. RESULTADOS: Verificou-se nos grupos B e C formacao de area desprovida de coloracao na pequena curvatura gastrica, sendo significativamente maior no grupo C (p< 0,05). Nos grupos A e D tais areas nao foram observadas. A analise estatistica nao revelou diferencas significativas entre os resultados dos tres metodos utilizados. CONCLUSOES: Nas condicoes desse estudo os resultados permitiram concluir que nos animais com o estomago integro e naqueles onde a esplenectomia foi realizada de forma isolada, a vascularizacao do estomago permitiu a perfusao de toda a superficie do orgao. Nos animais submetidos a VGP isolada e principalmente quando a VGP foi associada a esplenectomia ocorreu significativa diminuicao do suprimento sanguineo na curvatura gastrica menor, sugerindo a potencialidade isquemica dessa regiao.

Oxidative stress and changes in the content and pattern of tissue expression of β-catenin protein in diversion colitis

OBJECTIVE: The aim of this study is to verify if oxidative stress is related to changes in content and pattern of β-catenin protein expression in an experimental model of diversion colitis. METHODS: Sixty Wistar rats were submitted to intestinal bypass. The animals were divided into three groups according to the sacrifice to take place in six, 12 and 18 weeks. For each group, five animals only underwent laparotomy (control). The presence of colitis was diagnosed by histological study, and its severity, by inflammation grading scale. Cellular oxidative stress was measured by comet assay. Tissue expression of β-catenin protein was analyzed by the immunohistochemistry and quantification of its tissue content by computerized morphometry. Statistical analysis was performed with the Students t-test, median, Mann-Whitney, ANOVA and Kruskal-Wallis, adopting a significance level of 5% (p <0.05). RESULTS: Colon segments without fecal stream developed colitis, which worsened with time of exclusion. Segments without fecal stream suffer higher levels of oxidative stress when compared to those with stream, and it worsens with time of exclusion. The levels of cellular oxidative stress are directly related to the degree of inflammation. The total content of β-catenin in segments without fecal stream reduces after six weeks, and does not vary thereafter. The content of β-catenin in the apical portion of the colon crypts decreases with time, whereas in the basal region, it increases. The total content of β-catenin is inversely related to the degree of inflammation and levels of tissue oxidative stress levels. CONCLUSION: There are changes in tissue content of E-cadherin and increased expression of β-catenin in proliferative regions of colonic crypts, related with oxidative tissue stress.