Luís César Fernandes

NM23 protein expression in colorectal carcinoma using TMA (tissue microarray): association with metastases and survival

CONTEXT NM23, a metastasis suppressor gene, may be associated with prognosis in patients with colorectal carcinoma. OBJECTIVE To analyze NM23 expression and its association with the presence of lymph node and liver metastases and survival in patients operated on for colorectal carcinoma. METHODS One hundred thirty patients operated on for colorectal carcinoma were investigated. Tissue microarray blocks containing neoplastic tissue and tumor-adjacent non-neoplastic mucosa were obtained and analyzed by immunohistochemical staining using a monoclonal anti-NM23 antibody. Immunohistochemical expression was assessed using a semiquantitative scoring method, counting the percentage of stained cells. The results were compared regarding morphological and histological characteristics of the colorectal carcinoma, presence of lymph node and liver metastases, tumor staging, and patient survival. Statistical analysis was performed using the Mann-Whitney test, the Kruskal-Wallis test and Fishers exact test. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. RESULTS NM23 expression was higher in colorectal carcinoma tissue than in adjacent non-neoplastic mucosa (P<0.0001). NM23 protein expression did not correlate with degree of cell differentiation (P = 0.57), vascular invasion (P = 0.85), lymphatic invasion (P = 0.41), perineural infiltration (P = 0.46), staging (P = 0.19), lymph node metastases (P = 0.08), or liver metastases (P = 0.59). Disease-free survival showed significant association (P = 0.01) with the intensity of NM23 protein immunohistochemical expression in colorectal carcinoma tissue, whereas overall survival showed no association with NM23 protein expression (P = 0.13). CONCLUSIONS NM23 protein expression was higher in neoplastic colorectal carcinoma tissue than in adjacent non-neoplastic mucosa, showing no correlation with morphological aspects, presence of lymph node or liver metastases, colorectal carcinoma staging, or overall survival. Disease-free survival was higher in patients with increased NM23 expression.

Marcadores tumorais no câncer colorretal

Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Gastroenterologia Cirurgica

Feasibility analysis of loop colostomy closure in patients under local anesthesia

PURPOSE To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS The mean duration of the operation was 133 minutes (range: 85 to 290 minutes). The mean postoperative hospitalization was four days (range: one to twelve days). No patients died. Complications occurred in two patients (9.4%): abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21) and on the first postoperative day by 85% (18/21). At hospital discharge, 95.2% of the patients (20/21) said they were in favor of the local anesthesia technique. CONCLUSION Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

Diagnóstico e tratamento de tumores carcinóides do trato digestivo

The authors analyzed the characteristics of carcinoid tumors according to their site in the digestive tract. Despite their low speed of growing and metastasis process, such neoplasias are malignant and must be submitted to surgical resection. Advanced cases with metastases are treated with somatostatin derivatives, lessening symptoms, causing occasional regression of lesions and presenting an extended survival. Appendicular and rectal lesions have a better prognosis maybe due to the early diagnosis performed.

Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure

CONTEXT Studies in the area of health economics are still poorly explored and it is known that the cost savings in this area is becoming more necessary, provided that strict criteria. OBJECTIVE To perform a cost-effectiveness analysis of spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure. METHODS This was a randomized clinical trial with 50 patients undergoing loop colostomy closure either under spinal anesthesia (n = 25) or under local anesthesia plus sedation (n = 25). The duration of the operation, time spent in the post-anesthesia recovery room, pain, postoperative complications, length of hospital stay, laboratory and imaging examinations and need for rehospitalization and reoperation were analyzed. The direct medical costs were analyzed. A decision tree model was constructed. The outcome measures were mean cost and cost per local and systemic postoperative complications avoided. Incremental cost-effectiveness ratios were presented. RESULTS Duration of operation: 146 +/- 111.5 min. vs 105 +/- 23.6 min. (P = 0.012); mean time spent in post-anesthesia recovery room: 145 +/- 110.8 min. vs 36.8 +/- 34.6 min. (P<0.001). Immediate postoperative pain was lower with local anesthesia plus sedation (P<0.05). Local and systemic complications were fewer with local anesthesia plus sedation (P = 0.209). Hospitalization + rehospitalization: 4.5 +/- 4.1 days vs 2.9 +/- 2.2 days (P<0.0001); mean spending per patient: R

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

5,038.05 vs 2,665.57 (P<0.001). Incremental cost-effectiveness ratio: R

Relationship between peripheral and mesenteric serum levels of CEA and CA 242 with staging and histopathological variables in colorectal adenocarcinoma

-474.78, indicating that the strategy with local anesthesia plus sedation is cost saving. CONCLUSION In the present investigation, loop colostomy closure under local anesthesia plus sedation was effective and appeared to be a dominant strategy, compared with the same surgical procedure under spinal anesthesia.

AVALIAÇÃO HISTOPATOLÓGICA E MORFOMÉTRICA INTESTINAL DOS EFEITOS DA ADMINISTRAÇÃO PROLONGADA DE CORTICOSTERÓIDE EM CÃES

CONTEXT Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. OBJECTIVES Randomized clinical trial to compare the results from these two techniques. METHODS Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25) and using local anesthesia (n = 25). Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin). Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. RESULTS Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. CONCLUSIONS Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.

Estudo comparativo de anastomoses colorretais com anel biofragmentável e com grampeador em cães submetidos à irradiação gama pré-operatória

OBJETIVO: Comparar variaveis histopatologicas e graus de estadiamento do adenocarcinoma colorretal com niveis sanguineos perifericos e mesentericos de CEA e CA-242. METODOS: Em 169 doentes submetidos ao tratamento cirurgico por adenocarcinoma colorretal, CEA e CA-242 foram analisados e comparados quanto aos niveis sanguineos perifericos e mesentericos e correlacionados com o tamanho e a morfologia macroscopica do tumor, grau de diferenciacao celular, invasoes venosa, linfatica, neural e a classificacao TNM. RESULTADOS: Verificou-se diferenca significante entre o nivel serico mesenterico e periferico de CEA (p= 0,02). Niveis sericos mais elevados dos marcadores foram observados e correlacionados com invasao venosa, CEA (P) p=0,013, CEA(M), p=0,05, CA-242 (M) p=0,005 e CA-242 (P) p=0,038. Grau de estadiamento TNM avancado foi associado com CEA(P) < CEA(M) p<0,05, CA-242(P) < CA-242(M) p<0,05. Nas maiores dimensoes tumorais constatou-se CEA(P) < CEA(M) p=0,001 e CA 242 (P) < CA 242 (M) (p < 0.001). O CA 242 periferico e mesenterico aumentados associaram-se com a invasao neural, p=0.014 e p=0.003, respectivamente. CONCLUSOES: O nivel serico mesenterico de CEA e superior ao nivel serico periferico. Os niveis sericos mesentericos e perifericos do CEA e do CA-242 sao mais elevados no adenocarcinoma com invasao venosa, de maior diâmetro e de estadios avancados. Existe uma associacao entre o nivel serico do Ca-242 e a invasao neural.PURPOSE To compare histopathological variables and staging in colorectal adenocarcinoma cases with CEA and CA 242 in peripheral and mesenteric blood. METHODS In 169 individuals underwent surgery for colorectal cancer, CEA and CA 242 were analyzed and compared to mesenteric and peripheral blood and correlated with macroscopic tumors morphology and size, degree of cell differentiation, venous, neural and lymphatic involvement and TNM classification. RESULTS There was a difference between the mesenteric (M) and peripheral (P) serum levels of CEA (p=0.020). Higher levels of markers were correlated with venous invasion CEA (P) p=0.013, CEA (M) p=0.05, CA 242 (M) p=0.005 and CA 242 (P) p=0.038; with advanced staging CEA (P) < CEA (M) (p < 0.05); CA 242 (P) < CA 242 (M) (p < 0.05); and with greater dimensions CEA (P) < CEA (M) (p < 0.001); CA 242 (P) < CA 242 (M) (p < 0.001). CA 242 became higher with neural invasion (P): p=0.014, (M): p=0.003). CONCLUSIONS There were higher mesenteric than peripheral levels of CEA. Both mesenteric and peripheral levels of CEA and CA 242 were higher in neoplasm with venous involvement, greater diameter and advanced stages. There was a correlation between CA 242 and neural invasion.

Value of carcinoembryonic antigen and cytokeratins for the detection of recurrent disease following curative resection of colorectal cancer.

Corticosteroids are largely used in the medical practice. However, they present side effects, that condition a risk factor for gastro-intestinal surgical procedures. The present study seeks to evaluate the histologycal changes of the mucosa and submucosa in colon of dogs submitted to the extended administration of corticosteroids. Fifteen male dogs with no defined pedigree, weighing 15 kg, randomized, being 6 dogs of the control group and 9 dogs of the experimental group, were submitted to the intramuscular application of hydrocortisone, 35 mg/kg/day for 30 days. The colonic distal segment was resected, fixed in Bouin and the courts were stained by the methods: PAS, alcian blue and HE. In the morphometric analysis, was accomplished the counting of: globet cells (GLO), absorptive cells (ABS), total cells (TOT= GLO+ABS), mitosis (MIT) and lymphocytes (LYMP) in each crypt; mast cells (MAST) in the submucosa. The histopathologycal evaluation revealed lymphocytic and plasma cells infiltrated, disorganization of the crypts, presence of pictotic cells, ulcerations in the mucosa; edema, vascular and lymphatic congestion in the submucosa. Analysis revealed: significant decrease of the number of GLO, ABS, TOT and LYMP, increase of MIT in the experimental group and non alteration of the number of MAST. It was concluded that the extended administration of corticosteroids in dogs induced significant histopathologycal and morphometric alterations in the colonic mucosa, that can be constituted important factors of surgical risk.