Exploratory analysis of radiomic as prognostic biomarkers in 18F-FDG PET/CT scan in uterine cervical cancer.

Objective: To evaluate the performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) radiomic features to predict overall survival (OS) in patients with locally advanced uterine cervical carcinoma. Methods: Longitudinal and retrospective study that evaluated 50 patients with cervical epidermoid carcinoma (clinical stage IB2 to IVA according to FIGO). Segmentation of the 18F-FDG PET/CT tumors was performed using the LIFEx software, generating the radiomic features. We used the Mann-Whitney test to select radiomic features associated with the clinical outcome (death), excluding the features highly correlated with each other with Spearman correlation. Subsequently, ROC curves and a Kaplan-Meier analysis were performed. A p-value < 0.05 were considered significant. Results: The median follow-up was 23.5 months and longer than 24 months in all surviving patients. Independent predictors for OS were found-SUVpeak with an AUC of 0.74, sensitivity of 77.8%, and specificity of 72.7% (p = 0.006); and the textural feature gray-level run-length matrix GLRLM_LRLGE, with AUC of 0.74, sensitivity of 72.2%, and specificity of 81.8% (p = 0.005). When we used the derived cut-off points from these ROC curves (12.76 for SUVpeak and 0.001 for GLRLM_LRLGE) in a Kaplan-Meier analysis, we can see two different groups (one with an overall survival probability of approximately 90% and the other with 30%). These biomarkers are independent of FIGO staging. Conclusion: By radiomic 18F-FDG PET/CT data analysis, SUVpeak and GLRLM_LRLGE textural feature presented the best performance to predict OS in patients with cervical cancer undergoing chemo-radiotherapy and brachytherapy.

Characteristics of patients diagnosed with cervical cancer in Brazil: preliminary results of the prospective cohort EVITA study (EVA001/LACOG 0215).

OBJECTIVES: Cervical cancer is the fourth most common cancer in women worldwide. Epidemiological and quality of life (QoL) data in patients with cervical cancer from low- and middle-income countries are scarce. We aimed to describe sociodemographic and clinicopathological characteristics and quality of life of patients with cervical cancer at diagnosis in Brazil. METHODS: EVITA is a prospective cohort study of newly diagnosed patients with cervical cancer from May 2016 to December 2017, stages I-IVB, from 16 Brazilian sites representing the five Brazilian regions. At baseline, medical evaluation was performed and European Organization for Research and Treatment of Cancer (EORTC) QLQ-CX24/C30 questionnaires were administered. RESULTS: A total of 631 patients were included. Mean±SD age was 49.3±13.9 years; skin color was non-white in 65.3%, and 68.0% had ≤8 years of formal education. In total, 85.1% of patients had a Pap smear. The main reasons reported by patients for not having a Pap smear were: lack of interest (46.9%), shame or embarrassment (19.7%), lack of knowledge (19.7%), and difficulty with access (9.1%). Most patients were diagnosed with locally advanced or metastatic disease (FIGO clinical stage II-IV in 81.8%- stage II in 35.2%, stage III in 36.1%, and stage IV in 10.5%). Patients with clinical stage III-IV had worse physical functioning and role functioning. CONCLUSIONS: Cervical cancer in Brazil is usually diagnosed at an advanced stage. Most patients have low formal education and are unemployed. Lack of interest was identified as a main reason for not having a screening test, and limited access was reported as a reason by <10% of the patients. Awareness campaigns must be a governmental priority, specially focused on the needy population, along with wide access to treatment.

Higher severity and risk of in-hospital mortality for COVID-19 patients with cancer during the year 2020 in Brazil: A countrywide analysis of secondary data.

BACKGROUND: Coronavirus disease 2019 (COVID-19) and cancer are serious public health problems worldwide. However, little is known about the risk factors of in-hospital mortality among COVID-19 patients with and without cancer in Brazil. The objective of this study was to evaluate the risk factors of in-hospital mortality among COVID-19 patients with and without cancer and to compare mortality according to gender and topography during the year 2020 in Brazil. METHODS: This was a secondary data study of hospitalized adult patients with a diagnosis of COVID-19 by real-time polymerase chain reaction testing in Brazil. The data were collected from the Influenza Epidemiological Surveillance Information System. RESULTS: This study analyzed data from 322,817 patients. The prevalence of cancer in patients with COVID-19 was 2.3%. COVID-19 patients with neurological diseases and cancer had the most lethal comorbidities in both sexes. COVID-19 patients with cancer were more likely to be older (median age, 67 vs 62 years; P < .001), to have a longer hospital stay (13.1 vs 11.5 days; P < .001), to be admitted to the intensive care unit (45.3% vs 39.6%; P < .001), to receive more invasive mechanical ventilation (27.1% vs 21.9%), and to have a higher risk of death (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.83-2.06; P < .001) than those without cancer. Patients with hematological neoplasia (aOR, 2.85; 95% CI, 2.41-3.38; P < .001) had a higher risk of mortality than those with solid tumors (aOR, 1.83; 95% CI, 1.72-1.95; P < .001) in both sexes. CONCLUSIONS: Brazilian COVID-19 patients with cancer have higher disease severity and a higher risk of mortality than those without cancer.

Canine Rabies in the Brazil-Bolivia Border Region from 2006 to 2014.

BACKGROUND: After 2006 the cross-border region between the state of Mato Grosso do Sul (Brazil) and the Germán Busch Province (Bolivia) became risk areas for canine rabies antigenic variant 1, previously unknown in the Brazilian territory. OBJECTIVES: To perform a descriptive analysis of canine rabies from 2006 to 2014, analyzing the database of the official rabies diagnostic laboratory of the State Agency of Animal and Plant Health Protection of Mato Grosso do Sul. METHODS: A descriptive analysis of canine rabies from 2006 to 2014 was performed using the database of the official rabies diagnostic laboratory of the State Agency of Animal and Plant Health Protection of Mato Grosso do Sul. Location, time and residence status of the animals were analyzed. Monthly frequencies were calculated as the ratio of the number of positive samples to the total of sent samples and were then statistically compared. FINDINGS: In the period, 539 samples of nervous system from dogs and cats were sent for rabies diagnosis, of which 37 (6.9%; CI95% 5.0-9.3) canine and no positive feline samples were found positive. Twenty-four (64.9%, CI95% 48.8-78.2) positive samples were from Bolivia and 13 (31.1%, CI95% 21.8-51.2) from Brazil. Most positive animals were owned. The years 2008 and 2009 showed the highest occurrence of canine rabies, with 18 cases recorded in 2008 and 6 in 2009 (17 in Bolivia and 7 in Brazil). Annual samples sent in Brazil presented a decreasing trend (R2 = 0.53) and, over the months, a higher concentration of samples was observed between May and August (R2 = 0.69). No annual or monthly trends were observed for Bolivian samples (R2 < 0.003). CONCLUSIONS: AgV1 canine rabies due to antigenic variant 1 is still considered an endemic disease in the Brazil-Bolivia border region, requiring an international One Health Approach to mitigate canine rabies in Latin America.

Padrões de tratamento, uso de recursos e custo do câncer de pulmão de não pequenas células avançado em instituições brasileiras privadas / Treatment patterns, resource use and cost-of-illness of advanced non-small lung cancer in Brazilian private institutions

Objetivo: No Brasil, dados clínicos e custos econômicos do câncer de pulmão de não pequenas células (CPNPC) são escassos. Portanto, conduzimos este estudo para coletar dados de mundo real sobre padrões de tratamento e uso de recursos para CPNPC avançado (CPNPCa) em pacientes em instituições privadas brasileiras. Métodos: Coletamos dados de prontuários de seis instituições privadas no Brasil. Os pacientes elegíveis tinham diagnóstico de CPNPC avançado ou recorrente (estágios IIIB e IV) entre janeiro de 2011 e julho de 2014, e haviam recebido pelo menos duas linhas de quimioterapia. Dados foram resumidos usando estatísticas descritivas e os custos foram estimados pela abordagem bottom-up. Resultados: Dos 430 pacientes selecionados, 152 foram elegíveis para coleta de dados. A idade mediana dos pacientes foi de 62 anos e 55,9% eram do sexo masculino. Entre os pacientes, 57,2% e 31,6% receberam três e quatro linhas de tratamento, respectivamente. Dezesseis e vinte regimes foram utilizados como tratamentos de primeira e segunda linha. Bevacizumabe carboplatina + paclitaxel (n = 32; 21,1%) foi o mais frequente na primeira linha, enquanto docetaxel isolado (n = 36; 23,7%) foi o regime mais comum de segunda linha. Hospitalizações e visitas ao pronto-socorro foram registradas em 52% e 25% dos pacientes, respectivamente. O custo total da coorte foi de R$ 47.692.195,1 (US$ 14.803.425,4). Conclusões: Os padrões de tratamento para pacientes com CPNPCa em instituições privadas brasileiras são heterogêneos. O alto uso e custos de recursos observados entre os pacientes da CPNPCa têm um impacto econômico significativo para o sistema de saúde privado brasileiro.

Objective: In Brazil, data on clinical and economic burden of non-small cell lung cancer (NSCLC) are scarce. Therefore, we conducted this study to gather real-world data on treatment patterns and resource use for advanced NSCLC (aNSCLC) patients in Brazilian private institutions. Methods: We collected data from medical charts from six private institutions in Brazil. Eligible patients were diagnosed with advanced or recurrent NSCLC (stages IIIB and IV) between January 2011 and July 2014, and had received at least two lines of chemotherapy. Data were summarized using descriptive statistics and costs estimated by bottom-up approach. Results: Out of 430 charts screened, 152 were eligible for data collection. Patients' median age was 62 years, 55.9% were male. Among patients, 57.2% and 31.6% had received three and four treatment lines, respectively. Sixteen and twenty regimens were used as first and second-line treatments, respectively. Bevacizumab + carboplatin + paclitaxel (n = 32; 21.1%) was the most frequent first-line regimens, while docetaxel (n = 36; 23.7%) the most common second-line regimen. Hospitalizations and ER visits were recorded from 52% and 25% of the patients, respectively. Total cohort costs were R$ 47,692,195.1 (US$ 14,803,425.4). Conclusions: Treatment patterns for patients with aNSCLC in Brazilian private institutions are heterogeneous. The observed high resource use and costs among aNSCLC patients have a significant economic impact to the Brazilian private healthcare system.

Estudo de fase II avaliando a segurança e eficácia da quimioterapia neoadjuvante em pacientes com câncer de colo de útero localmente avançado / Phase II trial of neoadjuvant chemotherapy followed by chemoradiation in locally advanced cervical cancer

Introdução: o câncer de colo de útero é um problema de saúde pública no mundo. Desde 1999, radioterapia concomitante a quimioterapia baseada em platina constitui o tratamento padrão para pacientes com neoplasia localmente avançada. Entretanto, o prognóstico dessas pacientes permanece sombrio e abordagens alternativas, como por exemplo, a quimioterapia adjuvante ainda são controversas, especialmente pelo importante aumento de toxicidade. Quimioterapia neoadjuvante (QT neo) pode ser uma alternativa de intensificar o tratamento com melhor perfil de toxicidade. Métodos: foi realizado um estudo prospectivo, não-randomizado de fase II em um centro de referência de tratamento de câncer em Recife, Brasil. Pacientes com diagnóstico de carcinoma escamoso de colo de útero localmente avançado Ib2-IVa, foram submetidas a QT neo com cisplatina 35mg∕m2 e gencitabina 1000 mg∕m2 no D1 e D8, por dois ciclos. Em seguida, as pacientes realizavam radioterapia em pelve (50,4Gy) concomitante a cisplatina 40mg/m2, seguido de braquiterapia. Os objetivos primários foram taxa de resposta e toxicidade. A sobrevida livre de progressão e a sobrevida global foram objetivos secundários. Resultados: entre setembro/2013 e outubro/2015, 50 pacientes foram incluídas e completaram a QT neo seguida de quimioradioterapia...

Purpose: Cervical cancer is a global public health challenge. Since 1999, platin based chemoradiation (CRT) is the standard treatment for those patients with locally advanced disease. However, this population still has a dismal prognosis and, alternatives approaches such as adjuvant chemotherapy are controversial, especially because of increased toxicity. Neoadjuvant chemotherapy (NACT) could be an option for more intensive treatment with manageable toxicity. Methods: A phase II, prospective, non-randomized trial was conducted at a reference center in Recife, Brazil. Locally advanced cervical cancer patients (Ib2 - IVa) were treated with neoadjuvant cisplatin 35mg∕m2 and gemcitabine 1000 mg∕m2 D1 and D8, for 2 cycles. Then, they received CRT (50.4Gy) with weekly cisplatin 40mg∕m2 followed by brachytherapy. Response rate (RR) and toxicity were the primary endpoints. Progression-free survival (PFS) and overall survival (OS) were secondary endpoints. Results: Between Sep/2013 and Oct/2015, 50 patients were initiated on NACT and CRT. RR was 81% at the end of treatment. Haematological and gastrointestinal toxicity were most common. Grade 3/4 toxicity was 20% during NACT and 44% during CRT...

Neoadjuvant Chemotherapy Followed by Chemoradiation in Cervical Carcinoma: A Review.

OBJECTIVE: Cervical cancer is a public health problem. A large proportion of patients have locally advanced (LA) disease at presentation and for this group, neoadjuvant chemotherapy (NACT) has an undefined role in the era of chemoradiotherapy. In countries with restricted access to radiotherapy, NACT may precipitate patients' access to an effective treatment approach. We carried out a systematic review to evaluate available data about NACT followed by chemoradiation. METHODS: Studies evaluated the use of NACT followed by chemoradiotherapy. Search strategy was performed in MEDLINE, LILACS, and Cochrane Library from 2003 to 2013. Conference proceedings of American Society of Clinical Oncology annual meeting, International Journal of Gynecological Cancer Society biennial meeting, and European Society of Gynecological Oncology biennial meeting were also reviewed. Key words used were "cervical uterine cancer," "cervical uterine neoplasm," "neoadjuvant therapy," "neoadjuvant treatment," and "locally advanced." Data collected included author information, year of publication, study design, number of participants, eligibility criteria, treatment, response rate (RR), disease-free survival, overall survival, and toxicities. RESULTS: Initial searches retrieved 7670 references. There were 7 eligible trials. Only 2 studies were published and a total of 323 participants were recruited. Patients with LA disease were eligible in most of them. Neoadjuvant chemotherapy consisted of paclitaxel combined with a platinum compound. Compliance was more than 90% in published trials. Response rate to NACT ranged from 67.8% to 70%. Major toxicity was hematological. Survival was evaluated in different points in time. Overall survival was up to 93% in 2 years, and in a poor prognostic group, 81% of patients were alive after 22 months. However, we must interpret these results with caution because of data limitation. CONCLUSIONS: Our result raises the possibility of NACT as an alternative upfront treatment for these patients with a small risk of disease progression. In countries where radiotherapy network is limited, randomized clinical trials should clarify its role.

Integrated synthesis of zeolites 4A and Na-P1 using coal fly ash for application in the formulation of detergents and swine wastewater treatment.

Several researchers have reported zeolite synthesis using coal ash for a wide range of applications. However, little attention has been given to green processes, including moderate synthesis conditions, using waste as raw material and effluent reuse or reduction. In this study, Brazilian coal fly ashes were used for integrated synthesis of zeolites 4A and Na-P1 by two different routes and under moderate operating conditions (temperature and pressure). Both procedures produced zeolites with similar conversions (zeolite 4A at 82% purity and zeolite Na-P1 at 57-61%) and high CEC values (zeolites 4A: 4.5meqCa(2+)g(-1) and zeolites Na-P1: 2.6-2.8meqNH4(+)g(-1)). However, process 1 generated less effluent for the zeolite mass produced (7mLg(-1)), with low residual Si and Al levels and 74% of the Si available in the coal fly ash incorporated into the zeolite, while only 55% is used in process 2. For use as a builder in detergents, synthetic zeolite 4A exhibited conformity parameters equal to or greater than those of the commercial zeolite adopted as reference. Treatment of swine wastewater with zeolite Na-P1 resulted in a high removal capacity for total ammoniacal nitrogen (31mgg(-1)).

Meningeal carcinomatosis in solid tumors / Carcinomatose meníngea em tumores sólidos

The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome.

O acometimento leptomeníngeo por metástases tumorais pode ocorrer em tumores sólidos, sendo chamado de carcinomatose meníngea (CM), e também em doenças linfoproliferativas. Tumores de mama, pulmão e melanoma são os principais responsáveis pelos casos, e adenocarcinoma é a histologia mais frequentemente encontrada. A CM é um evento tardio na evolução da doença e caracteriza-se por sinais e sintomas neurológicos multifocais. O diagnóstico se faz pela avaliação conjunta do quadro clínico, neuroimagem e estudo do líquido cefalorraquidiano. O maior controle da doença sistêmica obtido com as novas modalidades terapêuticas e a baixa penetração de drogas no sistema nervoso central, aliados ao desenvolvimento nos métodos de neuroimagem observado nas últimas décadas, são fatores que respondem por um aumento na incidência desta apresentação. A quimioterapia intratecal é o tratamento de escolha, porém, frequentemente paliativo. O prognóstico é reservado, sendo que o melhor performance status pode selecionar um subgrupo de pacientes com melhor evolução.

Meningeal carcinomatosis in breast cancer: prognostic factors and outcome.

Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27-76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03-90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients.

Pathologic complete response with neoadjuvant imatinib for locally advanced pelvic GIST.

There are few data that show pathologic complete response (pCR) to imatinib treatment in gastrointestinal stromal tumors (GISTs). We describe a case of a patient with pCR of a pelvic, locally advanced, high-risk GIST who was treated with neoadjuvant imatinib and ultimately underwent a conservative procedure. A 48-year-old male presented with a pelvic mass 10 cm in diameter. Biopsy revealed a gastrointestinal stromal tumor of rectal origin. Although it was considered initially resectable, an extensive procedure would have been necessary for complete resection. Treatment with imatinib was initiated, resulting in partial response. The patient remained on imatinib for over 15 months, maintaining stable disease. Radical prostatectomy with anal sphincter preservation was performed. Pathological report revealed no viable neoplastic cells. The use of imatinib was held for 6 months after the surgery. At a follow-up 15 months after surgery, the patient had no evidence of disease. Our report may help to guide future studies of neoadjuvant imatinib for large pelvic or rectum GISTs that are initially considered unresectable.

Meningeal carcinomatosis in solid tumors.

The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome.

Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report / Metástases sincrônicas de carcinoma epidermoide de pulmão em tireoide e cólon: relato de caso

CONTEXT: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.

CONTEXTO: O câncer de pulmão de células não pequenas evolui, na maioria dos casos, com metástases a distância. Ossos, sistema nervoso central, glândula adrenal e fígado são os sítios mais frequentes de metástases. Disseminação para pele, miocárdio, tireoide e intestino pode ocorrer, entretanto é rara. RELATO DE CASO: Descrevemos um caso de carcinoma espinocelular (CEC) de pulmão com metástase em cólon e tireoide, em mulher de 66 anos. A lesão era irressecável, e foi iniciada quimioterapia. A paciente evoluiu com suboclusão intestinal e a colonoscopia evidenciou pólipo colônico cuja biópsia e imunoistoquímica (IHQ) foram compatíveis com CEC de origem pulmonar. Em consulta de acompanhamento, detectou-se nódulo tireoidiano cuja punção aspirativa e IHQ de cellblock confirmaram CEC de origem pulmonar. Após quimioterapia de terceira linha, a paciente evoluiu com abdome agudo obstrutivo por massa retroperitoneal, sendo submetida a laparotomia exploradora, vindo a falecer por complicações da cirurgia. Metástases para tireoide e cólon são raramente reportadas em carcinomas epidermoides de pulmão. O envolvimento gastrointestinal por metástases de pulmão pode acometer estômago, intestino delgado e cólon, e casos de sangramento e perfuração já foram reportados. Embora ricamente vascularizada, a tireoide é sítio infrequente de metástases. Os sítios refletem prognósticos reservados na evolução clínica. Não encontramos, na literatura, relato prévio de câncer de pulmão com metástases em cólon e tireoide concomitantes em um único paciente.

Synchronous thyroid and colon metastases from epidermoid carcinoma of the lung: case report.

CONTEXT: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.

Alkydic resin wastewaters treatment by fenton and photo-Fenton processes.

Advanced oxidation processes are an emerging option to treatment of the painting industry effluents. The aim of this study was to compare the effectiveness of the Fenton and photo-Fenton processes in chemical oxygen demand (COD), total organic carbon (TOC) and phenolic compounds removal from wastewaters generated during alkydic resins manufacture. The optimized treatment conditions are the following: pH 3.0, 15.15x10(-3)molL(-1) FeSO(4) and 0.30molL(-1) H(2)O(2) for a reaction time of 6h. photo-Fenton experiments were carried out in the presence of sunlight or artificial radiation and complementary additions of H(2)O(2) were made for all experiments. The best results were obtained with photo-Fenton process assisted with solar radiation, with reductions of 99.5 and 99.1% of COD and TOC levels, respectively. Fenton and photo-Fenton (with artificial irradiation) processes presented lower but not insignificant removals, within 60-80% reduction for both COD and TOC. In addition, an excellent removal (95%) of total phenols was obtained using photo-Fenton process assisted with artificial irradiation. This study demonstrated that the use of photo-Fenton process on alkydic resins wastewater treatment is very promising especially when solar light is used.

Alternative spectrophotometric method for standardization of chlorite aqueous solutions.

The chlorite ion is the principal by-product of the treatment of drinking water by chlorine dioxide. In function of the chlorite salt instability, standard solutions of this ion need standardization by iodometric titration, which is a reliable method although labor intensive and time consuming. An alternative method to standardization of aqueous chlorite solutions, based on its direct UV absorption measurement, was presented. Besides the maximum absorption (260 nm) generally used in other studies, the minimum (239 nm) and isosbestic (248 nm) wavelengths were proposed as supplementary points to chlorite quantification and their molar absorptivity coefficients were estimated (155.2+/-0.6, 104.5+/-1.0 and 69.0+/-1.2 L cm(-1) mol(-1), respectively). The direct spectrophotometric determination of chlorite could be made selectively even in the presence of high concentration of major contaminants (chorine dioxide, chloride and chlorate), being a simple and rapid method, consuming very low volume of sample and generating low quantities of laboratory wastes.