Biomarkers as predictors of mortality in critically ill patients with solid tumors.

Biochemical markers produced by the affected organ or body in response to disease have gained high clinical value due to assess disease development and being excellent predictors of morbidity and mortality. The aim of this study is to analyze different biochemical markers in critically cancer patients and to determine which of them can be used as predictors of mortality. This is a prospective, cross-sectional study conducted at a University Hospital in Porto Alegre - RS. Screening was done to include patients in the study. Serum biochemical markers obtained in the first 24 hours of Intensive Care Unit hospitalization were analyzed. A second review of medical records occurred after three months objected to identify death or Unit discharged. A sample of 130 individuals was obtained (control group n = 65, study group n = 65). In the multivariate model, serum magnesium values ​​OR = 3.97 (1.17; 13.5), presence of neoplasia OR = 2.68 (95% CI 1.13; 6.37) and absence of sepsis OR = 0.31 (95% CI 0.12; 0.79) were robust predictors of mortality. The association of solid tumors, sepsis presence and alteration in serum magnesium levels resulted in an increased chance of mortality in critically ill patients.

Epidemiological and Financial Aspects of Hospitalizations for Bacterial Meningitis in Brazil.

Introduction: Understanding the epidemiology and cost implications of acute bacterial meningitis is crucial for effective health planning, timely treatment implementation, and comprehensive patient support measures, as well as for determining appropriate hospital expenses. Therefore, we conducted an analysis of hospitalization cases for bacterial meningitis in Brazil from January 2008 to December 2019. Methods: This is a descriptive ecological study that utilized the Hospital Information System of Brazil's National Unified Health System (SIH/SUS) database. The variables included sex, region, age group, hospitalizations, deaths, lethality rate, and hospital service expenses. The data were tabulated to focus specifically on the epidemiological aspect of bacterial meningitis. Results: During the study period, there were 20,207 hospitalizations for bacterial meningitis in Brazil. Men accounted for a higher number of cases, with 11,690 (57.67%), while women had a higher lethality rate of 10.64%. The Southeast region had the highest percentage of both hospitalizations (45.78%) and deaths (46.42%). Bacterial meningitis remains an important cause of morbidity and mortality, particularly in children under 5 years of age. Notably, the elderly and the Northeast region showed higher rates of lethality. The total expenditure on hospital services exceeded 43 million in Brazilian real, with the highest expenditure observed in 2019 and the lowest in 2011. Conclusion: A higher prevalence of the disease was observed in males, in children under 1-year-old and in the southeast region. Hospital expenditures were found to be substantial and increasing over time, underscoring the significance of early diagnosis and the promotion of vaccination campaigns.

Preoperative nutritional assessment and prognosis in patients with foregut tumors.

Malnourished patients with gastrointestinal tumours are at risk for postoperative complications and death. The aim of this study was to determine which nutritional assessment method better predicts outcome. Seventy-four patients, 45 men and 29 women; mean (SD) age of 63 (102) yr (range = 34 to 83), undergoing surgical resections for esophageal (n = 19) gastric (n = 43) and pancreatic (n = 12) tumors were preoperatively assessed by Patient Generated Subjective Global Assessment, anthropometry, and by laboratory sampling. Forty-three (58%) of them were unnourished; 25 Subjective Global Assessment (SGA)-A, 34 SGA-B, and 15 SGA-C cases. Mean (SD) of dominant hand adductor pollicis muscle thickness (DAPM) was 13 (3.5) mm and mean (SD) serum albumin was 3.8 (0.5) g/dL. Mean (SD) hospital staying for patients who complicated and died was 34 (29) days and 23 (13) days for survivors (not significant); SGA-B cases were significantly associated with higher mortality (n = 12, P<0.001). Patients with a mean (SD) DAPM below 10.8 (3.7) mm died more frequently than those with a mean (SD) greater than 14 (3) mm (P < 0.001). None of the methods was significantly related to hospital stay, but receiver operating characteristic curves (95% confidence interval) for PG-SGA and DAPM thickness (0.75 and 0.74) reliably predicted mortality (P<0.001) and these methods may be used as preoperative parameter.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT.

BACKGROUND: : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. AIM: : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. METHODS: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS: : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. CONCLUSION: : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 1): AN UPDATE ON DIAGNOSIS, STAGING, ENDOSCOPIC TREATMENT AND FOLLOW-UP.

BACKGROUND: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. AIM: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. METHODS: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. CONCLUSION: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.

Femoral and acetabular revision using impacted nondemineralized freeze-dried bone allografts.

BACKGROUND: Favorable results have been obtained by the use of deep-frozen bone allografts in total hip arthroplasty. However, owing to the shortage of deep-frozen allografts and the risk of infectious disease, other materials have been studied, such as sterile nondemineralized freeze-dried allografts. The aim of this study was to describe midterm clinical outcomes and radiographic bone incorporation of human freeze-dried bone grafts in 42 revision total hip arthroplasty procedures using cancellous impacted bone grafting. METHODS: This report presented clinical and radiographic evidence of allograft incorporation in 42 hip reconstructions performed between 1996 and 2002. The patient group included 13 (31%) men and 29 (69%) women with mean +/- SD age of 63 +/- 14 years (range 28-80 years). Mean follow-up was 82 months (range 63-127) months. Clinical analysis was based on the D'Aubigné-Postel score. Radiographic incorporation was defined according to specific criteria. RESULTS: The D'Aubigné and Postel criteria showed adequate outcome in 38 (90%) of the patients. The radiographic evaluation revealed that allograft remodeling and incorporation were found in 39 (93.0%) and 36 (86.5%) of acetabular and femoral cases, respectively. The overall graft survival rate at an average follow-up of 8 years (range 5-10 years) was 90%. CONCLUSIONS: Bone grafts obtained by the lyophilization process developed and carried out in our tissue bank provide suitable grafts for revision total hip arthroplasty. Clinical and radiographic midterm results were excellent, indicating that nondemineralized freeze-dried bone allografts are suitable for replacing deep-frozen grafts.

NUTRIC score use around the world: a systematic review. / Uso do escore NUTRIC pelo mundo: uma revisão sistemática.

OBJECTIVE: To collect data on the use of The Nutrition Risk in Critically Ill (NUTRIC) score. METHODS: A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Reviews, abstracts, dissertations, protocols and case reports were excluded from this review; to be included in the review, studies needed to specifically evaluate the NUTRIC score and to have been published in English, Spanish or Portuguese. RESULTS: We included 12 (0.8%) studies from our search in this review. Ten studies (83.3%) were observational, 1 was a pilot study (8.3%) and 1 was a randomized control trial (8.3%). All of the included studies (100%) chose not to use IL-6 and considered a high nutritional risk cutoff point ≥ 5. There were 11 (91.7%) English language studies versus 1 (8.3%) Spanish language study. Mechanical ventilation and a high NUTRIC score were significantly correlated in four studies. The association between intensive care unit or hospital length of stay and nutritional high risk was significant in three studies. Seven studies found a statistically significant association between the NUTRIC score and mortality. CONCLUSION: The NUTRIC score is related to clinical outcomes, such as length of hospital stay, and is appropriate for use in critically ill patients in intensive care units.

OBJETIVO: Coletar dados a respeito do uso do escore Nutrition Risk in Critically Ill (NUTRIC). MÉTODOS: Conduziu-se pesquisa sistemática da literatura em conformidade com as especificações PRISMA. Excluíram-se da pesquisa os trabalhos referentes a revisões, resumos, dissertações, protocolos e relatos de caso. Foram incluídos estudos que avaliaram especificamente o escore NUTRIC publicados em inglês, espanhol ou português. RESULTADOS: Incluímos 12 (0,8%) estudos de nossa busca nesta revisão. Dez eram estudos observacionais (83,3%), um estudo piloto (8,3%) e um ensaio randomizado e controlado (8,3%). Em todos os estudos incluídos (100%), os autores decidiram não utilizar dosagem de interleucina 6 e consideraram como ponto de corte para alto risco nutricional um escore ≥ 5. Dentre os estudos selecionados, 11 (91,7%) estavam em idioma inglês e um (8,3%) em espanhol. Ventilação mecânica e o escore NUTRIC tiveram correlação significante em quatro estudos. A associação entre o tempo de permanência no hospital ou na unidade de terapia intensiva e o alto risco nutricional apresentou correlação significante em três estudos. Sete estudos identificaram associação estatisticamente significante entre escore NUTRIC e mortalidade. CONCLUSÃO: O escore NUTRIC tem relação com desfechos clínicos, como tempo de permanência no hospital, e seu uso é apropriado em pacientes críticos na unidade de terapia intensiva.

Acetabular reconstruction with human and bovine freeze-dried bone grafts and a reinforcement device.

BACKGROUND: This is a cohort trial (1997-2005) of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG) and a reinforcement device. OBJECTIVE: To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS: There were two groups: I (n=26) receiving human grafts and II (n=25) receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d'Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn's et al. criteria for radiographic bone incorporation. RESULTS: No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424). CONCLUSION: The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty.

Use of dietary fibers in enteral nutrition of critically ill patients: a systematic review. / Uso de fibras dietéticas em nutrição enteral de pacientes graves: uma revisão sistemática.

To meet the nutritional requirements of patients admitted to intensive care units, it is necessary to establish a diet schedule. Complications associated with enteral nutrition by tube feeding are not uncommon and may reduce the delivery of required nutrient to patients in intensive care units. Research on the osmolality, fat content, caloric intensity and fiber content of formulas are under way, and a substantial number of studies have focused on fiber content tolerability or symptom reduction. We conducted a systematic review of dietary fiber use and safety in critically ill patients in 8 studies based on diarrhea, other gastrointestinal symptoms (abdominal distension, gastric residual volume, vomiting and constipation), intestinal microbiota, length of stay in the intensive care unit and death. We discussed the results reported in the scientific literature and current recommendations. This contemporary approach demonstrated that the use of soluble fiber in all hemodynamically stable, critically ill patients is safe and should be considered beneficial for reducing the incidence of diarrhea in this population.

Para atender as necessidades nutricionais de pacientes admitidos às unidades de terapia intensiva, é necessário estabelecer um plano dietético. As complicações associadas com a nutrição enteral administrada por tubo não são incomuns e podem reduzir o fornecimento das necessidades nutricionais a pacientes internados na unidade de terapia intensiva. Encontram-se em andamento pesquisas relativas a osmolaridade, gorduras, intensidade calórica e conteúdo de fibras das fórmulas, e muitos estudos têm focado na tolerabilidade ao conteúdo de fibras ou na redução de sintomas. Conduzimos uma revisão sistemática do uso e segurança das fibras dietéticas em pacientes críticos, que envolveu oito estudos e teve como base diarreia, outros sintomas gastrintestinais (distensão abdominal, volume gástrico residual, vômitos e constipação), microbiota intestinal, tempo de permanência na unidade de terapia intensiva, e óbito. Discutimos os resultados encontrados na literatura científica, assim como as recomendações atuais. Esta abordagem contemporânea demonstrou que o uso de fibras solúveis em todos os pacientes graves hemodinamicamente estáveis é seguro e deve ser considerado benéfico para redução da incidência de diarreia nesta população.

CD117 Expression in Squamous Cell Carcinoma of the Oesophagus.

BACKGROUND/AIM: Identification of changes in specific genes may help new attempts in finding targeted therapy for oesophageal cancer which still has a very poor prognosis. The aim of this study was to investigate CD117 expression in squamous cell carcinoma of the oesophagus (SCCO). MATERIALS AND METHODS: A preliminary study was performed for CD177 immunoreactivity using a monoclonal antibody against CD117 on 27 SCCO specimens from patients who underwent surgical resection. Specimens of oesophageal mucosa obtained from 10 healthy individuals were studied as a control group. RESULTS: Most patients had TNM American Joint Committee on Cancer stage IIb or III SCCO and mean overall survival was 21 (range=2-72) months. Cytoplasmic membrane CD117 immunoreactivity was demonstrated in only four (15%) out of 27 tumours and in none of the controls. CONCLUSION: Although immunohistochemical expression of CD117 was higher than previously demonstrated, the lack of expression does not warranty further use in targeted therapy of SCCO.

Predicting factors of postoperative complications in appendectomies. / Fatores preditores de complicações pós-operatórias em apendicectomias.

OBJECTIVE: to evaluate the main risk factors for postoperative complications in patients undergoing appendectomy for acute appendicitis. METHODS: we retrospectively analyzed 1241 patients undergoing open or laparoscopic appendectomy. Patients were allocated to four groups: Group 1, without postoperative complications, and Groups 2, 3, and 4, with postoperative complications defined according to their severity, following Clavien-Dindo classification (I, II, and ≥III, respectively). RESULTS: patients aged ≥38.5 years had more severe complications (p<0.0001). Patients in Group 1, without postoperative complications, had, for the most part, a laparoscopic approach. Groups 2, 3, and 4 underwent, predominantly, to an open surgery (p<0.0001). In cases of acute appendicitis, the odds ratio (OR) for complications was 3.09, 3.04, and 12.41 for Groups 2, 3, and 4, respectively (p<0.0001). Anesthetic risk, duration of the procedure, and length of hospital stay were related to a higher risk and severity of complications. CONCLUSION: the main predicting factors of postoperative complications in patients operated for acute appendicitis were: age ≥38.5 years, conventional or open surgical access, complicated appendicitis, ASA≥2, and surgical time >77 minutes.

OBJECTIVE: avaliar os principais fatores de risco para complicações pós-operatórias em pacientes submetidos à apendicectomia por apendicite aguda. METHODS: foram analisados retrospectivamente 1241 pacientes submetidos à apendicectomia aberta ou laparoscópica. Os pacientes foram alocados em quatro grupos: Grupo 1, sem complicações pós-operatórias, e Grupos 2, 3 e 4, com complicações pós-operatórias, definidas de acordo com sua gravidade, conforme classificação de Clavien-Dindo I, II e ≥III, respectivamente. RESULTS: pacientes com idade ≥38,5 anos tiveram complicações mais graves (p<0,0001). Os pacientes do Grupo 1, sem complicações pós-operatórias, foram predominantemente operados por via laparoscópica. Os Grupos 2, 3 e 4 foram, em sua maior parte, operados por via convencional (p<0,0001). Razão de chances de complicações para apendicite complicada foi de 3,09, 3,04 e 12,41 para os Grupos 2, 3 e 4, respectivamente (p<0,0001). Risco anestésico, duração do procedimento e tempo de internação hospitalar estiveram relacionados com maior risco e gravidade de complicações (p<0,0001). CONCLUSIONS: os principais fatores preditores de complicações pós-operatórias em pacientes operados por apendicite aguda foram: idade ≥38,5 anos, acesso cirúrgico convencional ou aberto, apendicite complicada, ASA≥2 e tempo cirúrgico >77 minutos.

Role of BI-RADS Ultrasound Subcategories 4A to 4C in Predicting Breast Cancer.

BACKGROUND: The Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) categorization revised in 2013 by the American College of Radiology resulted in unquestionable standardization of reports and confirmed category 3 and 5 as benign and malignant lesions, respectively. In contrast, suspected images (category 4) have subcategorization criteria, although theses have been detailed difficult to apply. The aim of the present study was to determine the role of the US 4A to 4C BI-RADS subcategories in predicting malignancy. PATIENTS AND METHODS: We performed a cross-sectional study of diagnostic tests to estimate the performance of the US BI-RADS categorization to clearly differentiate benign from malignant lesions. A total of 975 US examinations performed at the Hospital Femina, Grupo Hospitalar Conceição teaching hospitals from January 2012 through March 2015 were included in the present study. The US BI-RADS lexicon was used to classify the examination findings. Suspicious lesions underwent core needle biopsy, and the US and histology reports were compared to determine the performance using receiver operating characteristic curves. RESULTS: Overall, the BI-RADS US categorization showed good discriminating accuracy with a receiver operating characteristic curve of 91% (95% confidence interval [CI], 88%-93%). However, BI-RADS subcategory 4b had a positive predictive value of 25% (95% CI, 20%-31%) and subcategory 4A had a positive predictive value of only 6% (95% CI, 3.5%-9.8%). CONCLUSION: Our results have shown that US BI-RADS subcategories 4A and 4B are clearly unfit for use in screening tests, because they cannot rule out the need for biopsy. Therefore, management will not be improved by subcategorizing category 4, because all suspicious lesions will still require definite biopsy.

PROGNOSTIC VALUE OF CARCINOEMBRYONIC ANTIGEN LEVELS IN TRANSOPERATIVE PERITONEAL LAVAGE IN PATIENTS WITH GASTRIC CANCER.

BACKGROUND: The carcinoembryonic antigen level in peritoneal lavage has been showing to be a reliable prognostic factor in gastric cancer. AIM: To identify any association between carcinoembryonic antigen level in peritoneal lavage, in gastric cancer patients, with mortality, peritoneal recurrence, tumor relapse or other prognostic factors. METHODS: In total, 30 patients (22 men, 8 women; median age 66 years) with resectable gastric cancer (mainly stage III and IV) were studied. Carcinoembryonic antigen level in peritoneal lavage was detected at operation by immunocytochemical method and a level over 210 ng/g of protein was considered as positive. RESULTS: There were detected 10 positive cases (33.3%) of plCEA levels. These levels were associated with mortality, RR: 2.1 (p=0.018); peritoneal recurrence, OR: 9.0 (p=0.015); and relapse or gastric cancer progression, OR: 27.0 (p=0.001). CONCLUSION: Increased levels of plCEA fairly predicts mortality, peritoneal recurrence tumor relapse or cancer progression.

Clinical, laboratory and densitometric comparison of patients with coxarthrosis and femoral neck fractures. / Comparação clínica, laboratorial e densitométrica de pacientes com coxartrose e com fraturas do colo femoral.

OBJECTIVE: to compare clinical, laboratory and densitometric data from patients with osteoarthrosis and femoral neck fractures. METHODS: we conducted a cross-sectional study of patients with femoral neck fracture and hip osteoarthrosis submitted to hip arthroplasty. We collected clinical, laboratory and densitometric data. RESULTS: we included 53 patients, 22 with femoral neck fractures and 31 with osteoarthrosis. Patients with femoral neck fractures were older than patients with osteoarthrosis, with lower BMI values, bone mineral density and palmar grip strength (sarcopenic patients), being more neurologically impaired and presenting a worse ASA score. Among the various biochemical parameters analyzed, we found statistically significant differences in total serum calcium, ionized calcium, vitamin D, free thyroxine, erythrocytes, hemoglobin, hematocrit, total white blood cells, neutrophils, lymphocytes and creatinine between the two groups. Other hormones analyzed and biochemical parameters did not differ significantly, although they showed trends between the two groups. CONCLUSION: patients with femoral neck fractures are older than patients with osteoarthrosis, have a lower weight and BMI, are more debilitated, many with anemia and reduced bone mass, and have a significant decrease in total calcium, ionized calcium, vitamin D and creatinine and a significant increase in free thyroxine.

ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER.

BACKGROUND: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment. AIM: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality. METHODS: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile. RESULTS: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007). CONCLUSION: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

Score of "eat-ability" as a predictor of malnutrition in patients with gastrointestinal tract cancer: a pilot study.

INTRODUCTION: decreased food intake, loss of appetite, and dysphagia are relevant symptoms in patients with gastrointestinal tract (GIT) cancer. However, these symptoms have been isolated or indirectly assessed when comprising quality of life questionnaires or risk assessment tools. OBJECTIVE: to determine whether a combined assessment of dysphagia, appetite and food intake may be used as a parameter of eat-ability (food capacity) in patients with GIT cancer. METHODS: a cross-sectional pilot study on 41 patients with GIT cancer were evaluated using a score for "eat-ability"(SEA) as compared to the Patient Generated Subjective Global Assessment(PG-SGA), anthropometry and laboratory profile. RESULTS: eleven (27%) patients had full eat-ability(SEA 0), three (7%) had moderate (SEA 1) and 27 (66%) had poor (SEA ≥ 2) eat-ability, which were significantly different, between upper and lower GIT tumors (p ≤ 0.05). By ROC curves, SEA 1 and ≥ 2 showed an 80% for both sensibility (95% CI: 0.48-0.95) and specificity (95% CI: 0.63-0.91) to PG-SGA (A and B), with an area under curve (AUC) of 0.79 (95% CI: 0.64-0.95) (p = 0.006). Patients with SEA ≥ 2 had a significant weight loss within three (p = 0.001) and six months (p < 0.001) when compared to patients with SEA 0 and 1. Mortality was also significantly higher (p = 0.01) among patients with critical food capacity by SEA (77%) in severely malnourished patients by PG-SGA (84%). CONCLUSION: by combining food intake, dysphagia and appetite assessment altogether, a reliable score clearly demonstrated compromised eating capacity affecting nutritional status of patients with GIT tumors at a higher risk for death.

Inflammatory and nutritional statuses of patients submitted to resection of gastrointestinal tumors.

OBJECTIVE: to evaluate the association between the nutritional and the inflammatory statuses of patients with cancer of the gastrointestinal tract undergoing surgical resection and to identify predictors of mortality in these patients. METHODS: we conducted a prospective study of 41 patients with gastrointestinal tract cancer submitted to surgery between October 2012 and December 2014. We evaluated the nutritional status by subjective and objective methods. We assessed the inflammatory response and prognosis using the modified Glasgow Prognostic Score (mGPS), Neutrophil/Lymphocyte Ratio (NLR), Onodera Prognostic Nutritional Index (mPNI), Inflammatory-Nutritional Index (INI) and C-Reactive Protein/Albumin ratio (mPINI). RESULTS: half of the patients were malnourished and 27% were at nutritional risk. There was a positive association between the percentage of weight loss (%WL) and the markers NLR (p=0.047), mPINI (p=0.014) and INI (p=0.015). Serum albumin levels (p=0.015), INI (p=0.026) and mPINI (p=0.026) were significantly associated with the PG-SGA categories. On multivariate analysis, albumin was the only inflammatory marker independently related to death (p=0.004). CONCLUSION: inflammatory markers were significantly associated with malnutrition, demonstrating that the higher the inflammatory response, the worse the PG-SGA (B and C) scores and the higher the %WL in these patients. However, further studies aimed at improving surgical outcomes and determining the role of these markers as predictors of mortality are required.

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy.

OBJECTIVES: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. METHODS: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA), classical anthropometry, current weight and height, percentage of weight loss (%WL) and body mass index (BMI). We also measured the thickness of the thumb adductor muscle (TAM) in both hands, dominant hand (TAMD) and non-dominant hand (TAMND), as well as the calculated the prognostic nutritional index (PNI). The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC). RESULTS: of the 44 patients studied, 29 (66%) were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval) of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. CONCLUSION: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.

Expression of the p53 protein and clinical and pathologic correlation in adenocarcinoma of the rectum.

BACKGROUND: p53 is a tumor suppressor gene that has been implicated in the pathogenesis of a wide range of tumors, including colorectal cancer. AIM: To evaluate the prognostic significance of p53 protein expression, and to correlate with clinical and pathologic variables as well as survival. PATIENTS AND METHODS: Immunohistochemical staining for p53 protein was performed in a series of 83 patients with rectal cancer with a follow-up of at least 5 years. RESULTS: Expression of nuclear protein was positive in 36 (43.4%) of the tumors. We found association between positive p53 and death, local recurrence, distant metastasis and overall recurrence and we also found association between p53 and death, local recurrence, metastasis and overall recurrence when analysis was adjusted to Astler-Coller stage and grade of differentiation. CONCLUSION: p53 immunoexpression has shown to be an independent prognostic factor in these series.

DO PROXIMAL AND DISTAL GASTRIC TUMOURS BEHAVE DIFFERENTLY?

Background: Although the incidence of gastric (adenocarcinoma) cancer has been decreasing over time, it is still one of the most common malignancies worldwide, and proximal tumours tend to have a worse prognosis. Aim: To compare surgical outcomes and prognosis between proximal - excluding tumours of the cardia - and distal gastric cancer. Methods: Out of 293 cases reviewed - 209 with distal and 69 with proximal gastric cancer - were compared for clinical and pathological features, stage, surgical outcome, mortality and survival. Results: Statistically, there was no significant difference between patients in both groups regarding mortality (p=0.661), adjuvant chemotherapy (p 0.661), and radiation (p=1.000). However, there was significant difference in the degree of lymph node dissection employed (p=0.002) and the number of positive lymph nodes resected (p=0.038) between the two groups. The odds of death at five years for patients who had a D0 dissection was three times greater (odds ratio 2.78; (95%CI 1.33-5.82) than that for patients who had a D2 dissection, while for patients who had a D1 dissection the odds ratio was only 1.41 (95%CI 0.71-2.83) compared to D2-dissected patients. Conclusion: Although no significant differences were found between proximal and distal gastric cancer, the increased risk of death in D0- and D1-dissected patients clearly suggests an important role of radical D2 lymph node dissection in survival.

Racional: Embora a incidência do câncer gástrico esteja diminuindo nas últimas décadas, ele ainda aparece como uma das neoplasias malignas mais comuns, e tumores proximais tendem a ter pior prognóstico. Objetivo: Comparar os resultados cirúrgicos e o prognóstico entre o câncer gástrico proximal, excluindo os tumores da cárdia e junção esofagogástrica, e o distal. Métodos: De 293 casos revistos - 209 distais e 69 proximais - foram comparados quanto aos achados clínicos e patológicos, estágio, resultados cirúrgicos, mortalidade e sobrevida. Resultados: Estatisticamente não houve diferença entre pacientes em ambos os grupos quanto à mortalidade (p=0.661), emprego de quimioterapia adjuvante (p=0.661) e de radioterapia (p=1.000). Entretanto, houve diferença significativa no grau de dissecção linfonodal empregada (p=0.002) e no número de linfonodos positivos ressecados (p=0.038) entre os dois grupos. A razão de chances para morte em cinco anos nos casos de dissecção D0 foi três vezes maior (2,78; IC95% de 1,33 a 5,82) do que a D2, enquanto que para dissecção D1, ela foi apenas 1,41 vezes maior (95%CI 0.71-2.83) quando comparado à D2. Conclusão: Ainda que não se tenha observado diferenças significativas entre o câncer gástrico proximal e o distal, o risco de morte aumentado nos casos de D0 e D1, claramente demonstra o papel preponderante da linfadenectomia radical D2 no tratamento dessa doença.