Toxicological findings about an anticancer fraction with casearins described by traditional and alternative techniques as support to the Brazilian Unified Health System (SUS).

ETHNOPHARMACOLOGICAL RELEVANCE: Extracts, essential oils and molecules from Casearia sylvestris have popularly shown pharmacological actions against chronic diseases, as anxiety, inflammation, cancer and dyslipidemia. In the context of antitumoral therapy, we investigated in vitro, ex vivo and in vivo toxicological changes induced by a Fraction with Casearins (FC) and its component Casearin X isolated from C. sylvestris on animal and vegetal cells, and upon invertebrates and mammals. MATERIAL AND METHODS: Cytotoxicity was carried out using normal lines and absorbance and flow cytometry techniques, Artemia salina nauplii, Danio rerio embryos and meristematic cells from Allium cepa roots. Acute and 30 days-mice analysis were done by behavioral, hematological and histological investigations and DNA/chromosomal damages detected by alkaline Cometa and micronucleus assays. RESULTS: FC was cytotoxic against lung and fibroblasts cells and caused DNA breaks, loss of integrity and mitochondrial depolarization on ex vivo human leukocytes. It revealed 24 h-LC50 values of 48.8 and 36.7 µg/mL on A. salina nauplii and D. rerio embryos, reduced mitotic index of A. cepa roots, leading to cell cycle arrest at metaphase and anaphase and micronuclei. FC showed i.p. and oral LD50 values of 80.9 and 267.1 mg/kg body weight. Subacute i.p. injections induced loss of weight, swelling of hepatocytes and tubules, tubular and glomerular hemorrhage, microvesicular steatosis, lung inflammatory infiltration, augment of GPT, decrease of albumin, alkaline phosphatase, glucose, erythrocytes, and lymphocytes, and neutrophilia (p > 0.05). FC-treated animals at 10 mg/kg/day i.p. caused micronuclei in bone marrow and DNA strand breaks in peripheral leukocytes. CONCLUSIONS: This research postulated suggestive side effects after use of FC-related drugs, demonstrating FC as antiproliferative and genotoxic on mammal and meristematic cells, including human leukocytes, teratogenicity upon zebrafish embryos, myelosuppression, clastogenicity, and morphological and biochemical markers indicating liver as main target for FC-induced systemic toxicity.

Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions.

OBJECTIVE: To analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. METHODS: A retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. RESULTS: The main indication for the procedure was suspicion of advanced-stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5%. The lesion was confirmed as cancer in 73% of the patients. The major complication was pneumothorax (27.8%), which required chest tube drainage in 12.4% of the procedures. CONCLUSIONS: The principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure.

Biópsia aspirativa transtorácica por agulha fina guiada por TC de lesões pulmonares: resultados e complicações / Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

OBJETIVO: Analisar os resultados citológicos de biópsias aspirativas percutâneas por agulha fina guiada por TC de pulmão, demonstrar a viabilidade diagnóstica do método na investigação de lesões pulmonares e determinar as complicações do procedimento, avaliando sua segurança. MÉTODOS: Análise retrospectiva com 89 pacientes com tipos diversos de lesões pulmonares que foram submetidos a 97 procedimentos em um período de cinco anos. Os pacientes foram divididos em grupos de acordo com a indicação para o procedimento: suspeita de neoplasia pulmonar primária (estádios IIIB e IV); suspeita de neoplasia pulmonar (estádios I, II e IIIA) e contraindicações clínicas para cirurgia; suspeita de metástase pulmonar oriunda de outros órgãos; e lesões pulmonares com aspecto radiológico benigno. O método foi padronizado com agulha fina de 25 gauge. Todos os procedimentos foram guiados por TC helicoidal. O diagnóstico final foi confirmado por biópsias cirúrgicas e acompanhamento clínico/oncológico. Para a análise das complicações, foi considerado o número total de procedimentos. RESULTADOS: A principal indicação do procedimento foi a suspeita de neoplasia pulmonar primária avançada. O método apresentou acurácia de 91,5 por cento para lesões malignas. A lesão foi confirmada como neoplásica em 73 por cento dos pacientes. A principal complicação foi o pneumotórax (27,8 por cento), com necessidade de drenagem tubular em 12,4 por cento do total de procedimentos. CONCLUSÕES: A principal indicação para biópsia por agulha fina guiada por TC foi a suspeita de doença neoplásica pulmonar primária sem possibilidade de tratamento cirúrgico. O procedimento tem alta viabilidade diagnóstica para doenças pulmonares de origem neoplásica. A mais prevalente complicação foi o pneumotórax, sem necessidade de drenagem tubular na maioria dos casos. Não ocorreram óbitos relacionados ao procedimento.

OBJECTIVE: To analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. METHODS: A retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. RESULTS: The main indication for the procedure was suspicion of advanced-stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5 percent. The lesion was confirmed as cancer in 73 percent of the patients. The major complication was pneumothorax (27.8 percent), which required chest tube drainage in 12.4 percent of the procedures. CONCLUSIONS: The principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure.