Sabas Carlos Vieira

Preoperative pelvic lymphoscintigraphy is of limited usefulness for sentinel lymph node detection in cervical cancer.

OBJECTIVES To analyze concordance between preoperative lymphoscintigraphy and intraoperative lymphatic mapping (ILM) for sentinel lymph node identification using technetium 99m-labeled-dextran 500 (99m-Tc) and patent blue dye in patients with early cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy, as well as to evaluate sentinel lymph node (SLN) detection. STUDY DESIGN Forty-seven patients underwent surgical treatment for cervical cancer. For SLN identification, 99m-Tc and blue patent were injected into the cervix on the eve and day of surgery, respectively. Preoperative pelvic lymphoscintigraphy was performed in all patients after 99m-Tc injection. Concordance between preoperative lymphoscintigraphy and ILM was evaluated. RESULTS Of the 56 patients who underwent preoperative lymphoscintigraphy, 43 (81.13%) had at least one lymph node identified. Bilateral lymph nodes were identified in 21 (37.5%) patients. Sentinel lymph nodes detected on ILM had been previously found on preoperative lymphoscintigraphy in 66.7%, 67.2% and 0% in the right, left and central locations, respectively. In 14 patients (25%), only one lymph node was identified on preoperative lymphoscintigraphy, but more than one sentinel lymph node was detected on intraoperative mapping. In nine (16.1%) patients, lymphoscintigraphy showed only unilateral lymph nodes, but ILM identified bilateral sentinel lymph nodes. CONCLUSION The combination of patent blue and radionuclide techniques produced excellent results for SLN detection in cervical cancer. Preoperative lymphoscintigraphy does not offer any advantage over ILM for SLN identification.

Prevalence of prognostic factors for cancer of the uterine cervix after radical hysterectomy

CONTEXT AND OBJECTIVE Cancer of the uterine cervix is still very common in Brazil. It is important to evaluate factors that influence its prognosis. The aim here was to analyze the prevalence of prognostic anatomoclinical factors among patients with carcinoma of the uterine cervix undergoing radical hysterectomy. DESIGN AND SETTING Cross-sectional study on 301 patients with invasive carcinoma of the uterine cervix who underwent Level III Piver-Rutledge hysterectomy surgery at São Marcos Hospital. METHODS The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node metastasis, distance to nearest margin, tumor invasion depth, vaginal cuff size, largest diameter of the tumor, presence of necrosis and surgical margin involvement. Descriptive statistics, multiple regression analysis, Kaplan-Meier survival curves and the log-rank test were performed. A significance level of 5% was used. RESULTS The mean age was 48.27 years. The following were not important for the prognosis, in relation to survival analysis: degree of differentiation and tumor invasion depth; presence of lymphatic, blood and perineural invasions; distance to nearest margin; and vaginal cuff size. Tumor size (P < 0.036), presence of lymph node metastasis (P < 0.0004), necrosis (P < 0.05) and surgical margin involvement (P < 0.0015) presented impacts on survival. The overall survival with 98 months of follow-up was 88.35%. CONCLUSION The most prevalent prognostic factors were the presence of lymph node metastasis, tumor size and surgical margin involvement.

Exenteração pélvica para câncer do colo uterino recidivado pós-radioterapia: experiência de um centro terciário do Nordeste brasileiro

OBJETIVO: analisar complicacoes, morbidade, mortalidade e sobrevida num grupo de pacientes com câncer de colo uterino com recidiva pelvica central submetidas a exenteracao pelvica pos-tratamento primario com radioterapia. METODOS: estudo retrospectivo de uma serie de 16 casos de exenteracao pelvica pos-tratamento primario com radioterapia. Foi realizada estatistica descritiva, curva de sobrevida pelo metodo de Kaplan-Meier e analise de regressao linear multipla para avaliar fatores prognosticos. RESULTADOS: dezesseis pacientes foram submetidas a exenteracao pelvica. O carcinoma epidermoide, o estadio IIb e o grau indiferenciado foram as condicoes mais frequentes. A recidiva tumoral pos-operatoria ocorreu na metade dos casos. Onze pacientes apresentaram complicacoes perioperatorias ou pos-operatorias e as mais frequentes foram infeccoes pelvica e da ferida operatoria e fistulas urinarias. A sobrevida global foi de 64,3%, com um seguimento mediano de 11 meses. A analise de regressao linear multipla nao revelou fatores prognosticos significativos na sobrevida das pacientes. CONCLUSOES: a taxa de sobrevida foi de 64,3%. Nenhum fator associado a pior prognostico foi encontrado nesta serie.PURPOSE to analyze complications, morbidity, mortality and survival rate in a group of patients with cervical cancer with central pelvic relapse after primary radiotherapy treatment. METHODS retrospective study of a series of 16 cases of pelvic exenteration after primary radiotherapy treatment. Descriptive statistics, survival curve through Kaplan-Meiers method, and regression analysis to evaluate prognosis were performed. RESULTS sixteen patients have undergone pelvic exenteration. Epidermoid carcinoma, IIb stage and undifferentiated grade were the most frequent conditions. Post-operatory tumor relapse occurred in half the cases. Eleven patients presented peri or post-surgical complications, the most frequent being pelvic infection, that of the surgical wound, and urinary fistulae. Global survival rate was 64.3%, with average follow-up of 11 months. Regression analysis did not detect any significant prognosis factor for the patient survival. CONCLUSIONS the survival rate was 64.3%. No particular factor associated to poor prognosis has been found in the present series of cases.

Estudo do linfonodo sentinela no câncer do colo uterino com azul patente

OBJECTIVE The purpose of this study was to determine the feasibility of sentinel node identification in patients with invasive cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy using intraoperative lymphatic mapping with patent blue dye. METHODS Fifty one patients wtih Figo I and II cervical cancer were submitted to radical hysterectomy and pelvic lymphadenectomy. The patent blue V was injected around the tumor before beginning surgery. At the time of pelvic lymphadenectomy, lymph nodes with obvious uptake of the dye were separated from the remainder of the lymphadenectomy specimen. RESULTS Sentinel nodes were detected in 32 of the 51 patients. Four cases of false negative were observed. The specificity, sensitivity, positive predictive value and negative predictive value were 38.6%, 42.8%, 10% and 80.9%, respectively. CONCLUSIONS Identification of sentinel node with patent blue dye is feasible in cervical cancer. A larger series will be required to establish sentinel detection in cervical cancer for further therapy concepts and planning.

Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010

BACKGROUND While representing only 3-4% of malignant skin tumors, cutaneous melanoma is the most aggressive and lethal. Statistical knowledge about the biological behavior of this tumor is essential for guiding daily outpatient practice and aiding public health policies. OBJECTIVES To analyze the profile of patients with cutaneous melanoma attending a pathology department in Teresina (state of Piauí) between 2000 and 2010. METHODS Retrospective study of melanoma patients diagnosed between 2000 and 2010 in the São Marcos Hospital in the city of Teresina. The pathology laboratory reports were studied and all the statistical analyses performed using SPSS 19.0. RESULTS A total of 25 in situ, 199 invasive and 89 metastatic melanomas of unknown primary site were observed. Histological types found were nodular (52.8%), superficial spreading melanoma (18.6%), acral (10.6%) and lentigo maligna (9.5%). In 144 (73.4%) cases the Breslow thickness was >1 mm. Metastasis was found in 28.6% of invasive melanomas and nodular melanoma, Clark IV/ V, Breslow > 1 mm, mitotic index ≥ 6 and ulcerated lesions were more likely to metastasize. CONCLUSION Most melanomas presented Breslow> 1mm. The main factors associated with metastasis were nodular type, Clark IV / V, Breslow> 1mm, mitotic index ≥ 6 and ulcerated lesions.

Linfonodo sentinela em melanoma: experiência inicial de um centro do nordeste brasileiro

The incidence of skin melanoma is increasing worldwide. The presence of lymph node metastasis is the most important prognostic factor of this disease, the thicker the lesion the greater the likelihood of lymph node involvement. Approximately 20% of patients with Breslow depth 1-4 mm have lymph node metastasis. Sentinel lymph node biopsy is standard procedure in the management of patients with skin melanoma, reflecting progress in the treatment of this disease since this procedure avoids an unnecessary radical lymphadenectomy, thus reducing the morbidity of treatment. This paper describes a series of cases involving sentinel lymph node biopsy in melanoma patients in Teresina, Piauí, Brazil between 2008 and 2009.

Genital myiasis in a woman with psychiatric disturbance.

A 56-year-old Brazilian woman with psychiatric disturbance was found unconscious in a forested rural area in a state of precarious general hygiene with multiple scratches all over her body and a fracture of her left collarbone. Gynaecological examination revealed areas of vulvar–perineal necrosis secondary to infestation by fly larvae (Fig. 1). Speculum examination revealed an epithelised cervix and a Papanicolaou smear showed no signs of malignancy. Due to the presence of areas of necrosis in the vulvar and perineal areas, the patient was submitted to surgical debridement of the region during which a great quantity of larvae was removed and the area was cleaned with antiseptic solution. During surgical debridement, we observed that the anal canal and sphincter musculature were also affected. A sigmoid loop colostomy was carried out. The patient remained in the hospital for 10 days during which she was given antibiotics, analgesics and anti-inflammatory medication, and was submitted to daily local asepsis of the area with an antiseptic solution. Larvae had to be removed up to the fourth day of hospitalisation. The fracture was treated expectantly and routine laboratory tests presented no abnormal results. The larvae were identified as Cochliomyia hominivorax. The woman’s lesions were completely healed after two months and the colostomy was closed after one year.

Cateteres venosos centrais totalmente implantáveis para quimioterapia: experiência com 793 pacientes

OBJECTIVE: To retrospectively study the results obtained with the implementation of totally implantable catheters in patients undergoing chemotherapy. METHODS: 815 totally implantable catheters placed in 793 patients undergoing chemotherapy regimen, preferably using the right cephalic vein. We evaluated early and late complications. RESULTS: The retrospective analysis showed an average duration of 339 days of the catheters. In 733 (90%) catheters there was no observe complication. Among early complications we observed one pneumothorax, one bad positioning of the catheter, one arterial puncture, one bleeding, one hemothorax and hemomediastinum and six hematomas in the implantation site. As for late complications, there were 35 catheter-related infections ten, infections in the surgical site, six obstructions and 20 thromboses. We removed 236 catheters, 35 due to complications and 201 by the end of treatment. CONCLUSION: totally implantable catheters for chemotherapy are a safe means for the administration of substances, in view of the low number of complications observed in this study.

Hemangioma de mama simulando metástase no PET-CT

Breast hemangioma is a rare benign tumor that presents either absent or low 18F-fluoro-2-deoxy-D-glucose (FDG) uptake at positron emission tomography (PET). The authors report the case of a breast nodule pathologically compatible with hemangioma in a woman whose PET-scan has demonstrated increased FDG uptake (simulating a malignant tumor). A brief review of factors leading to false positive and false negative PET results is also undertaken.

Síndrome da mama fantasma: características clínicas e epidemiológicas

PURPOSE: to evaluate the clinical and epidemiological characteristics of patients with the diagnosis of phantom breast syndrome or with phantom phenomena lonely. METHODS: it was conducted an observational, descriptive and sectional study enrolling 98 patients treated for breast cancer at Hospital Sao Marcos, Teresina (PI), Brazil. A standardized questionnaire was applied. RESULTS: the phantom breast syndrome was observed in 11.2% of the patients and phantom sensation alone was observed in 30% of the patients. The mean age of the patients was 54 years. Fifty-nine patients were married (60%) and 79.5% were analphabetic or had not concluded the high school. Emotional alterations were present in 67.4%, even though in 66.7% the libido was not changed after surgical procedure. As a relief factor of phantom pain, resting was cited by 90.9% of the patients, while physical exercises were mentioned to exacerbate the symptoms in 63.6% of the cases. The mean grade attributed to the pain in a 0 to 10 scale was 3, ranging from 1 to 7. Only 3% of the patients knew about the existence of this syndrome before the interviews. CONCLUSIONS: phantom phenomena are frequent in mastectomized patients, being necessary more studies to know about its characteristics and effects in these womens quality of life.