Uncovering the armpit of SBRT: An institutional experience with stereotactic radiation of axillary metastases.

Purpose/objectives: The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to its use in varying anatomic locations. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes and process. Materials/methods: Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF. Results: We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5. Conclusion: Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.

Cytomegalovirus Identification in Blood and Urine of Newborns by Nested Polymerase Chain Reaction.

AIM: To study the frequency of congenital cytomegalovirus (CMV) infection in newborns admitted to the Division of Neonatology, using nested polymerase chain reaction (PCR) and DNA to detect differences in blood and urine specimens. METHODS: The study was carried out for eight months. Newborns (n = 520) hospitalized in five hospitals in Campo Grande, Mato Grosso do Sul, Brazil, were checked for CMV by analysing blood and urine samples. RESULTS: Cytomegalovirus was PCR positive in 13 urine and 10 blood samples. Of the 13 positive urine patients, three (23%) had no clinical signs suggestive of CMV, and another three (23%) patients admitted to the neonatal intensive care unit (NICU) had no definite findings of bacterial infection, with negative blood culture and some clinical signs consistent with CMV as cholestasis, hepatomegaly and eosinophilia. Three patients were on mechanical ventilation and showed improvement after prescription of ganciclovir. One CMV positive child progressed to death. CONCLUSION: Cytomegalovirus detection in urine was slightly more efficient than in blood, and showed better sensitivity than in serological analysis (p < 0.01) therefore, boiled urine may be a better and easier specimen tool for CMV diagnosis in neonatal infection. The findings of the present research suggest that patients admitted to the NICU, especially premature infants, whose laboratory results are not compatible with bacterial infection, and exhibiting signs suggestive of CMV infection should have PCR done on urine for confirmation.

Cultivo in vitro de Brosimum gaudichaudii Tréc. (Moraceae) / In vitro cultivation of Brosimum gaudichaudii Tréc. (Moraceae)

O objetivo desta pesquisa foi avaliar o potencial organogenético de entrenós, discos foliares, e raízes de Brosimum gaudichaudii utilizando 12 diferentes combinações dos fitorreguladores 6-benzilaminopurina e ácido naftaleno acético, em meio MS (diluído à metade), sólido (6,5 g de ágar), e com 20 g.L-1 de sacarose. Independentemente das combinações hormonais testadas verificou-se a formação de calos friáveis (2 a 20 mm de diâmetro) em 90% dos entrenós usados como explantes. No entanto, os tratamentos testados não foram capazes induzir calos ou gemas em raízes e em discos foliares. O estudo anatômico revelou a formação de meristemóides nas regiões mais externa e mais interna dos calos. Os resultados obtidos poderão servir de base para novos testes de indução de calos na espécie.

The objective of this research was to evaluate the organogenic potential of internodes, leaf discs and roots of Brosimum gaudichaudii using 12 different combinations of the plant growth regulators 6-benzylaminopurine and naphthalene acetic acid in MS medium (half strength), solid medium (6.5 g agar) and sucrose medium (20 g.L-1). Regardless the hormonal combination tested, we observed the formation of friable calluses (2 - 20 mm wide) in 90% of the internode explants. However, the treatments were not able to induce callus or buds on roots and leaf discs. The anatomical analysis revealed meristemoid formation in the outer and inner regions of the calluses. The results may serve as the basis for further testing of callus induction in this species.

Myocardial ischemia induced by nebulized fenoterol for severe childhood asthma.

We examined for myocardial ischemia induced by continuous inhalation of fenoterol in children with severe acute asthma. Thirty children with severe acute asthma were evaluated for signs of myocardial ischemia when treated with 0.5 mg kg dose (maximum 15 mg) of inhaled fenoterol for one hour. The heart rate was measured before and after inhalation. Cardiac enzymes (creatine kinase, creatine kinase MB fraction and troponin levels) were measured at admission and 12 hours later. An EKG was recorded before inhalation was started and immediately after its completion to detect the presence of any evidence of myocardial ischemia. All patients developed significant increase in heart rate. Six patients showed EKG changes compatible with myocardial ischemia, despite normal enzyme levels. Patients with severe acute asthma show tachycardia and may show EKG changes of myocardial ischemia.

Clinical and biochemical study of 28 patients with mucopolysaccharidosis type VI.

This paper presents data collected by a Brazilian center in a multinational multicenter observational study of patients with mucopolysaccharidosis type VI (MPS VI), aiming at determining the epidemiological, clinical, and biochemical profile of these patients. Twenty-eight south-American patients with MPS VI were evaluated through medical interview, physical exam, echocardiogram, electrocardiogram, ophthalmologic evaluation, quantification of glycosaminoglycans (GAGs) in urine, and measurement of the activity of N-acetylgalactosamine-4-sulfatase (ARSB) in leukocytes. 92.9% of patients were Brazilian. Mean age at diagnosis and at evaluation was 48.4 months and 97.1 months, respectively. 88% of patients had onset of symptomatology before the age of 36 months. Consanguinity was reported by 27% of the families. Mean weight and height at birth were 3.481 kg and 51.3 cm, respectively. The most frequently reported clinical manifestations were short stature, corneal clouding, coarse facial features, joint contractures, and claw hands. All patients presented with echocardiogram changes as well as corneal clouding. Mean ARSB activity in leukocytes was 5.4 nmoles/h/mg protein (reference values: 72-174), and urinary excretion of GAGs was on average 7.9 times higher than normal. The number of clinical manifestations did not show a significant correlation with the levels of urinary GAGs nor with the ARSB activity. Also, no significant correlation was found between the levels of urinary GAGs and the ARSB activity. It was concluded that MPS VI has high morbidity and that, when compared with data published in the literature, patients in our study were diagnosed later and presented with a higher frequency of cardiological findings.

[A perspective on the control of myositis ossificans progressiva] / Miosite ossificante progressiva: uma perspectiva no controle da doença.

OBJECTIVE: To report four cases of myositis ossificans progressiva, its form of presentation, in addition to new control and treatment options. DESCRIPTION: The authors describe four cases of myositis ossificans progressiva, presenting its clinical manifestations, evolution, and available forms of control and treatment. The main congenital anomalies associated with myosistis ossificans progressiva are described, namely: hallux valgus, clinodactyly, short thumbs, exostosis, and syndactyly. The evolution and therapeutic responses of clinical improvement to oral ascorbic acid and biphosphonate in patients 1 and 4 are also described; patient 1 had a better response after receiving intravenous biphosphonate, while patients 2 and 3 showed clinical improvement after the administration of oral ascorbic acid. COMMENTS: Ascorbic acid relieves the pain and improves psychism in patients with myositis ossificans progressiva. Intravenous biphosphonate is an alternative to patients with significant worsening of the disease, especially those with ambulatory restrictions. The orientation towards avoiding recurrent trauma in myositis ossificans progressiva patients is important.

Endotracheal inhalatory sodium nitroprusside in severely hypoxic newborns.

This study examined the response of 10 newborns admitted to the Neonatal Intensive Care Unit of Hospital Universitário, UFMS, Campo Grande, MS, Brazil, submitted to mechanical ventilation under the following ventilator parameters: FiO2 = 100%, PIP (24 mmHg, rate > 30 mpm. All had severe hypoxia and were treated with a solution of sodium nitroprusside (SNP) administered through a special adapter for continuous endotracheal inhalation. Significant increases in PaO2, SaO2 and in PaO2/FiO2 ratio were observed at 1 h and at 6-8 h of treatment, whereas blood pressure did not change significantly while treatment was being delivered. No side effects such as methemoglobinemia or cyanogen accumulation were observed. Although appropriate studies using animal models have still to be conducted, present results suggest that endotracheal inhalation of SNP could constitute a valid form of treatment for newborns with persistent pulmonary hypertension or severe hypoxia of difficult management.