Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update.

PURPOSE: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil. METHODS: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence. RESULTS: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease. CONCLUSION: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.

Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: How to Apply New Evidence in Clinical Practice.

Cytoreductive nephrectomy (CN) followed by systemic therapy had been considered the standard of care for metastatic renal cell carcinoma (mRCC) patients since two clinical trials established its role during the cytokines era. With introduction of new and effective drugs, such as vascular endothelial growth factor-targeted therapies, the role of CN started to be challenged. Retrospective studies conducted during the targeted therapy era pointed to better outcomes when CN was associated with systemic treatment, although certain patients with poor risk features did not seem to benefit. Therefore, prospective clinical trials supporting CN were needed. Recently, with the publication of two randomized trials evaluating CN in the targeted therapy era, it has been made clear that patient selection and multidisciplinary discussion are of paramount importance in order to achieve the best outcomes. We reviewed the available literature on the role of CN among mRCC patients, commenting on how to apply the new evidence into clinical practice and providing future perspectives.

Azathioprine is more effective than mesalazine at preventing recurrent bowel obstruction in patients with ileocecal Crohn's disease.

BACKGROUND: Patients with subocclusive Crohn's disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction. MATERIAL/METHODS: Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups. RESULTS: There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67-8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons). CONCLUSIONS: In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.

Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn's disease patients.

BACKGROUND: Although the cost of Crohn's disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs. MATERIAL/METHODS We evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2-3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups. RESULTS: On an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients. CONCLUSIONS: Patients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.

[Assessment of surgical scars: a quantitative method]. / Avaliação de cicatrizes cutâneas: apresentação de um método quantitativo.

OBJECTIVE: To describe an objective assessment method, based on quantifiable criteria, and compare it with subjective patient and surgeon assessments. METHODS: 136 patients undergoing abdominal surgery were prospectively analyzed. Surgical scars were evaluated six months after surgery, with measurements of widening, hypertrophy and retraction. An objective 4-type scar classification (A, B, C and D) and a subjective 10-point surgeon and patient-assessed score were used. The results were compared. RESULTS: The surgeon's subjective assessment was different between groups 1 and 2 (p = 0.021) and between groups 2 and 3B (p = 0.011). Patients' assessments did not significantly differ between the groups (p = 0.283). The objective assessment gave better results for groups 1 and 3B, although without significance. The method used for objective assessment was effective and the surgeon's mean scores differed between the groups (p < 0.001). CONCLUSION: Assessment using the quantitative method was adequate to classify surgical scars, and agreed more with reality than a satisfaction-based subjective impression.

Avaliação de cicatrizes cutâneas: apresentação de um método quantitativo / Assessment of surgical scars: a quantitative method

OBJETIVO:Descrever um método objetivo de avaliação das cicatrizes cutâneas com base em critérios quantificados e compará-lo com avaliação subjetiva do cirurgião e do paciente. MÉTODOS: Foram analisados prospectivamente 136 pacientes submetidos à operações abdominais e inguinais. As cicatrizes foram avaliadas seis meses após o procedimento cirúrgico por meio da medida das alterações encontradas (alargamento, hipertrofia e retração). Essas cicatrizes foram classificadas em quatro tipos objetivos (A, B, C e D) e 10 subjetivos do cirurgião e do paciente (escore de 1 a 10). As classificações foram comparadas entre si. RESULTADOS: A avaliação subjetiva do cirurgião mostrou diferença entre os grupos 1 e 2 (p = 0,021) e 2 e 3B (p = 0,011). Na avaliação dos pacientes não houve diferença entre os grupos (p = 0,283). Em todos os grupos a avaliação do paciente foi mais satisfatória. A avaliação objetiva mostrou melhores resultados nos grupos 1 e 3B, sem diferença significativa. O método utilizado na avaliação objetiva foi eficaz e os valores médios atribuídos pelo cirurgião às cicatrizes dos tipos A, B, C e D foram diferentes entre si (p < 0,001). CONCLUSÃO: A avaliação pelo método quantitativo foi adequada para classificar cicatrizes cirúrgicas. Esse método esteve mais de acordo com a realidade do que a impressão subjetiva apoiada em satisfação com o resultado obtido.

OBJECTIVE: To describe an objective assessment method, based on quantifiable criteria, and compare it with subjective patient and surgeon assessments. METHODS: 136 patients undergoing abdominal surgery were prospectively analyzed. Surgical scars were evaluated six months after surgery, with measurements of widening, hypertrophy and retraction. An objective 4-type scar classification (A, B, C and D) and a subjective 10-point surgeon and patient-assessed score were used. The results were compared. RESULTS: The surgeon's subjective assessment was different between groups 1 and 2 (p = 0.021) and between groups 2 and 3B (p = 0.011). Patients' assessments did not significantly differ between the groups (p = 0.283). The objective assessment gave better results for groups 1 and 3B, although without significance. The method used for objective assessment was effective and the surgeon's mean scores differed between the groups (p < 0.001). CONCLUSION: Assessment using the quantitative method was adequate to classify surgical scars, and agreed more with reality than a satisfaction-based subjective impression.

Carcinoma de células fusiformes em terço médio esofágico: relato de caso e revisão da literatura / Spindle cell carcinoma of the middle esophagus: case report and literature review

O carcinoma de células fusiformes, também conhecido como carcinossarcoma, representa entre 0,5% e 1,5% das neoplasias malignas do esôfago e é caracterizado por volumosa lesão lobulada, causando pequena obstrução comparada ao seu volume. Este estudo apresenta um caso desta rara neoplasia em terço médio esofágico, que foi conduzida com tratamento cirúrgico e cujo diagnóstico foi confirmado por exame imunohistoquímico.

Spindle cell carcinoma, also known as carcinosarcoma, accounts for 0.5% to 1.5% of esophageal malignancies, and is characterized by a voluminous lobulated lesion leading to low-degree obstruction relative to its volume. We report a case of this rare condition in the middle esophagus, with the diagnosis confirmed through immunohistochemistry, and which was treated with surgery.

Conhecimento de anatomia aplicada ao trauma: estudo realizado com alunos da Faculdade de Enfermagem da Universidade Federal de Juiz de Fora / Anatomic knowledge applied to trauma: study done with the students of the nursing college of the Federal University of Juiz de Fora

Objetivou-se identificar o conhecimento dos alunos da Faculdade de Enfermagem da Universidade Federal de Juiz de Fora - UFJF sobre anatomia aplicada ao trauma, a importância que dão ao tema e o grau de satisfação com o conteúdo ministrado no curso de graduação...

Conduta na coledocolitíase / Management of choledocholithiasis

A coledocolitíase normalmente apresenta-se como complicação da colecistolitíase, ocorrendo em 10% a 20% das colecistectomias. Por ser esta a cirurgia mais realizada no mundo atualmente, faz-se mister conhecer a melhor opção terapêutica para cada paciente com suspeita de cálculos no colédoco. Esta revisão propõe-se a apontar as vantagens, as desvantagens e as indicações de cada procedimento terapêutico, visando a montagem de um algoritmo para o uso racional de diversas opções disponíveis no tratamento dos cálculos coledocianos.

Estudo revisional sobre a morfologia e as funçöes dos leucócitos / Revisional study of morphology and functions of leococytes

Revisäo bibliográfica da morfologia e propriedades químicas da Série Branca e suas principais funçöes, incluindo a fagocitose e ingestäo de partículas pelos neutrófilos, bem como suas funçöes secretórias. Descreve-se um estudo sobre o sistema fagocitário mononuclear e os linfócitos T e B, constatando-se a importância da análise da Série Branca para o profissional médico, seja para fim diagnóstico, terapêutico, ou de acompanhamento de uma patologia.