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1.
J Surg Oncol ; 121(4): 605-611, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32003475

RESUMO

BACKGROUND AND OBJECTIVES: Abdominal metastases (AM) from soft tissue sarcoma (STS) are rare and prognosis is poor. The aims of the study were to (a) identify risk factors for the development of AM and to (b) investigate the outcome of AM-patients. METHODS: Seven-hundred-sixty-nine STS-patients with localised disease at diagnosis treated at three tumour centres (2000-2016) were retrospectively included (409 males; mean age, 55.6 years [range, 8-96 years]; median follow-up, 4.1 years [interquartile-range, 2.5-6.6 years]). RESULTS: Two-hundred-two patients (26.3%) developed secondary metastases, and 24 of them AM (3.1%). Ten patients developed first AM (FAM) after a mean of 2.4 years and 14 patients late AM (LAM, after being diagnosed with metastases to other sites) after a mean of 2.0 years. Patients with liposarcoma had a significantly higher risk of developing AM (P = .007), irrespective of grading. There was no difference in post-metastasis-survival (PMS) between patients with AM at any time point and those with metastases to other sites (P = .585). Patients with LAM or FAM showed no difference in post-abdominal-metastasis-survival (P = .884). CONCLUSIONS: Survival in patients with AM is poor, irrespective of whether they develop secondarily to other metastases or not. Patients at high-risk of AM (ie, liposarcoma) may be followed-up regularly by abdominal-ultrasound/CT.


Assuntos
Neoplasias Abdominais/secundário , Neoplasias Abdominais/terapia , Extremidades/patologia , Sarcoma/patologia , Sarcoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
2.
J Surg Oncol ; 121(5): 743-758, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31970785

RESUMO

INTRODUCTION: Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. METHODS: This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. RESULTS: Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. CONCLUSION: Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.


Assuntos
Extremidades/patologia , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Biópsia , Brasil , Quimioterapia Adjuvante , Extremidades/cirurgia , Humanos , Linfonodos/patologia , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/terapia , Estadiamento de Neoplasias , Cuidados Paliativos , Complicações Pós-Operatórias/terapia , Radioterapia Adjuvante , Fatores de Risco , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia
3.
J Surg Oncol ; 121(4): 630-637, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31957034

RESUMO

BACKGROUND AND OBJECTIVES: Limb salvage surgery remains the standard treatment in bone and soft tissue tumors. Toronto Extremity Salvage Score (TESS) is the most used quality of life measure. Our objective was to perform cross-cultural adaptation and validation in Italian, testing test-retest reliability, construct validity, and responsiveness. METHODS: We interviewed patients already treated for content validity. A total of 124 patients completed TESS and other questionnaires presurgery, at 3 months, 3 months + 2 weeks, and 6 months follow-up. We calculated intraclass correlation coefficients (ICCs) for reliability, associations with Pearson's r, and change over time with paired T tests. RESULTS: A new item regarding touch-screen devices was added to the upper extremity (UE) questionnaire. ICC resulted of 0.99 for lower extremity (LE) and 0.98 for UE patients, Pearson's r between TESS and Musculoskeletal Tumor Society was .66 and .64, EuroQol-5D-5L r was .62 and .61, and r between TESS and short form-36 physical function subscale was .76 and .71 for LE and UE groups, respectively. Paired T test results were statistically significant to detect change over time (0.03, 0.04, and 0.04 for LE groups and 0.03, 0.01, and 0.04 for UE groups). CONCLUSION: The Italian version of TESS can be used for the bone and soft tissue sarcoma population in clinical trials in Italy and with Italian speaking patients abroad to ensure patients' perspectives for efficacy and efficiency of treatments.


Assuntos
Neoplasias Ósseas/psicologia , Neoplasias Ósseas/cirurgia , Salvamento de Membro/psicologia , Osteossarcoma/psicologia , Osteossarcoma/cirurgia , Sarcoma/psicologia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Comparação Transcultural , Extremidades/patologia , Extremidades/cirurgia , Feminino , Humanos , Itália , Linguagem , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/patologia , Qualidade de Vida , Reprodutibilidade dos Testes , Sarcoma/patologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Tradução , Adulto Jovem
4.
J Surg Oncol ; 121(1): 25-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31264724

RESUMO

BACKGROUND: This high volume, single center study investigated the prevalence, bacterial epidemiology, and responsiveness to antibiotic therapy of cellulitis in extremity lymphedema. METHODS: From 2003 to 2018, cellulitis events from a cohort of 420 patients with extremity lymphedema were reviewed. Demographics, lymphedema grading, symptoms, inflammatory markers, cultures and antibiotic therapy regimens were compiled from cellulitis episodes data. Univariate and multivariate analyses were performed for detailed analysis. RESULTS: A total of 131 separate episodes of cellulitis were recorded from 43 (81.1%) lower limb and 10 (19.9%) upper limb lymphedema patients. The prevalence and recurrence rates for cellulitis in lymphedema patients were 12.6% (53 of 420) and 56.6% (30 of 53), respectively. The most common findings were increased limb circumference (127 of 131; 96.9%) and abnormal C-reactive protein (CRP) level (86 of 113; 76.1%). Blood cultures were obtained in 79 (60.3%) incidents, with 9 (11.4%) returning positive. Streptococcus agalactiae was the most isolated bacterium (5 of 9; 55.5%). CONCLUSIONS: The cellulitis prevalence and recurrence rate in extremity lymphedema were 12.6%, and 56.6%, respectively. Strongest indicators of cellulitis were increased affected limb circumference and elevated CRP level. Empiric antibiotic therapy began with coverage for Steptococcus species before broadening to anti-Methicillin-resistant Staphylococcus aureus and anti-Gram negatives if needed for effective treatment of extremity lymphedema cellulitis.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/microbiologia , Linfedema/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/patologia , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/patologia , Estudos de Coortes , Extremidades/microbiologia , Extremidades/patologia , Feminino , Humanos , Linfedema/epidemiologia , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
5.
Med. clín (Ed. impr.) ; 153(9): 341-346, nov. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-186266

RESUMO

Introduction and objective: Transplantation of umbilical cord mesenchymal stem cells (UC-MSCs) has been shown to be effective in treating critical limb ischemia (CLI). However, the mechanism of MSCs-mediated improvements, especially on the immune-inflammatory aspects of this disease, is still unknown. In this study, we investigated the changes in T-lymphocyte subpopulations and inflammatory mediators (such as IL-6, IL-10 and TNF-alpha) in PBMCs from CLI patients after UC-MSCs treatment and correlation between inflammatory mediators and EPCs. Patients and methods: 8 patients received UC-MSCs transplantation. Before the treatment, at 24h and 1 month thereafter, peripheral blood samples were collected from 8 patients and 8 healthy volunteers. Patients were evaluated for changes in IL-6, IL-10, TNF-alpha and levels of circulating EPCs. Results: TNF-alpha and IL-6 serum levels increased at 24h (p=0.017, p=0.099) after treatment and then decreased at 1 month (p=0.031, p=0.072) compared with those before treatment. The percentages of CD3+T, CD3+CD4+T-lymphocytes and NK cells decreased significantly after UC-MSCs treatment (p=0.002, p=0.012 and p=0.029, respectively). TNF-alpha (r=−0.602, p=0.038) was shown to be inversely correlated with the number of circulating EPCs. Conclusions: This study demonstrates that UC-MSCs have anti-inflammatory and immunomodulation properties in CLI and suggests that UC-MSCs promote healing of non-healing wounds


Introducción y objetivo: El trasplante de células madre mesenquimales del cordón umbilical (CMM-CU) ha demostrado eficacia en el tratamiento de la isquemia crítica de las extremidades (ICE). Sin embargo, se desconoce el mecanismo de las mejoras mediadas por las CMM, especialmente en los aspectos inmune-inflamatorios de esta enfermedad. Este estudio analiza los cambios en las subpoblaciones de linfocitos T y en los mediadores inflamatorios (como IL-6, IL-10 y TNF-alpha) en CMSP de pacientes con ICE después del tratamiento con CMM-CU y estudia la correlación entre mediadores inflamatorios y células progenitoras endoteliales (CPE). Pacientes y métodos: Ocho pacientes recibieron trasplante de CMM-CU. Se recogieron muestras de sangre periférica de 8 pacientes y 8 voluntarios sanos, antes del tratamiento, a las 24h y un mes después. Los pacientes fueron evaluados para detectar cambios en IL-6, IL-10, TNF-alpha y niveles de CPE circulantes. Resultados: Los niveles séricos de TNF-alpha e IL-6 aumentaron 24h después del tratamiento (p=0,017, p=0,099) y luego disminuyeron al mes (p=0,031, p=0,072) en comparación con los niveles antes del tratamiento. Los porcentajes de CD3+T, CD3+CD4+ linfocitos T y células NK disminuyeron significativamente después del tratamiento con CMM-CU (p=0,002, p=0,012 y p=0,029, respectivamente). TNF-alpha (r=−0,602, p=0,038) demostró estar correlacionada inversamente con el número de CPE circulantes. Conclusiones: Este estudio demuestra que las CMM-CU tienen propiedades antiinflamatorias e inmunomoduladoras en la ICE y sugieren que las CMM-CU promueven la curación de heridas que no cicatrizan


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Isquemia/complicações , Transplante de Células-Tronco Mesenquimais/métodos , Cordão Umbilical/patologia , Células Progenitoras Endoteliais , Índice de Gravidade de Doença , Linfócitos T , Imunomodulação , Doença Arterial Periférica/terapia , Extremidades/patologia , Angiografia
6.
Med. clín (Ed. impr.) ; 153(9): 347-350, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186267

RESUMO

Fundamento y objetivo: Valorar la utilidad de una la escala de riesgo basada en la procalcitonina sérica (PCT) comparada con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) en la discriminación precoz entre la fascitis necrosante (FN) y la celulitis en las extremidades. Material y método: Estudio retrospectivo de pacientes consecutivos con diagnóstico confirmado de FN en una extremidad (n=11). Ese grupo de estudio fue comparado con 23 pacientes consecutivos con diagnóstico de celulitis severa en miembros en el mismo periodo. Se analizaron los datos clínicos y los parámetros rutinarios de laboratorio, siendo la variable principal el nivel sérico de PCT al ingreso. La capacidad de discriminación para el diagnóstico de FN de los dos métodos -nivel de PCT y puntuación de la escala LRINEC- fue evaluada mediante la curva COR y determinada por el cálculo del área bajo la curva (ABC). Resultados: El ABC fue significativamente mayor con la medición de la PCT, tanto como variable continua como cuando el riesgo era categorizado. El punto de corte para el nivel de PCT con mayor ABC bajo la curva fue a partir de 0,87ng/ml (sensibilidad 90,9%; especificidad 82,6%), mientras que alcanzaba una puntuación de 5 en la escala LRINEC (sensibilidad 72,7%; especificidad 82,6%). Conclusión: La medición de la PCT fue un método más efectivo que la escala LRINEC para discriminar precozmente entre FN y celulitis de las extremidades. Un nivel bajo de PCT, asociado al cuadro clínico y a la exploración física, es de especial utilidad para descartar el diagnóstico precoz de FN


Background and objective: To assess the usefulness of a risk scale based on serum procalcitonin (PCT) compared to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scale in the early discrimination between necrotising fasciitis (NF) and cellulitis of the extremities. Materials and methods: Retrospective study of consecutive patients with confirmed diagnosis of NF in one limb (n=11). This study group was compared with 23 consecutive patients with a diagnosis of severe limbs cellulitis during the same period. The clinical data and laboratory parameters were analysed, the main variable was the serum level of PCT upon admission. The capacity for NF diagnosis of the two methods, PCT level and LRINEC scale score, were evaluated by ROC curve and determined by the calculation of the area under the curve (AUC). Results: The AUC was significantly higher with PCT measurement, both as a continuous variable and when the risk was categorised. The cut-off point for the PCT level with the highest AUC under the curve was from 0.87ng/ml (sensitivity 90.9%, specificity 82.6%), whereas it was a score of 5 on the LRINEC scale (sensitivity 72.7%, specificity 82.6%). Conclusion: PCT measurement was a more effective method than the LRINEC score for early discrimination between NF and cellulitis of the extremities. A low level of PCT, associated with the patient's clinical status and physical examination is especially useful to rule out an early diagnosis of NF


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pró-Calcitonina/sangue , Fasciite Necrosante/diagnóstico , Celulite/diagnóstico , Extremidades/patologia , Índice de Gravidade de Doença , Estudos de Casos e Controles , Estudos Retrospectivos , Área Sob a Curva , Diagnóstico Precoce
7.
Anticancer Res ; 39(10): 5747-5753, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570477

RESUMO

BACKGROUND/AIM: Liposarcomas (LS) are one of the most common entities within the heterogenous group of soft tissue sarcomas. The aim of this study was to identify prognostic indicators in patients with LS of the extremities and truncal wall. PATIENTS AND METHODS: We analysed the influence of potential prognostic factors on local recurrence-free survival (LRFS) and overall survival (OS) in 181 patients who were suitable for surgical treatment with curative intent. RESULTS: The median follow-up period was 7.1 years. The 5-year LRFS and OS rates were 79.1 and 93.3%. The 5-year OS rate was 94.7% in patients with R0-resected primary tumors and 72.7% in patients with R1/R2-status (p=0.023). In multivariate analysis, only histologic grade was found to be an independent prognostic factor of OS. CONCLUSION: Negative margins were not an independent prognostic factor in our series. Tumor biology reflected by histologic grade dictated the outcome.


Assuntos
Extremidades/patologia , Lipossarcoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Lipossarcoma/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/patologia , Adulto Jovem
8.
An Bras Dermatol ; 94(4): 446-448, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644618

RESUMO

Necrolytic acral erythema is a distinct erythema that has been described as an extrahepatic manifestation of hepatitis C virus infection. Most reported cases have been in Africa, especially Egypt. We report the first case (to the best of our knowledge) of necrolytic acral erythema in a Chinese patient with HCV and HBV coinfection. We aim to increase awareness for recognizing this condition in the Chinese population.


Assuntos
Coinfecção/complicações , Eritema/patologia , Eritema/virologia , Hepatite B/complicações , Hepatite C/complicações , Adulto , China , Coinfecção/patologia , Extremidades/patologia , Hepatite B/patologia , Hepatite C/patologia , Humanos , Masculino , Necrose/virologia
9.
PLoS Negl Trop Dis ; 13(10): e0007762, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584959

RESUMO

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (LF) emphasizes hygiene, exercise, and other measures to reduce morbidity and disability related to LF. We recently reported that a portable, three-dimensional, infrared imaging system (3DIS) provides accurate limb volume measurements in patients with filarial lymphedema. To assess the practical utility of repeated 3DIS measurements for longitudinal lymphedema management, we examined intraday and day-to-day leg volume changes in adults with filarial lymphedema in southern Sri Lanka. METHODOLOGY AND PRINCIPAL FINDINGS: We assessed 41 participants with lower extremity lymphedema (stages 1-6) in their homes in the mornings (6:00-9:00 AM) and afternoons (2:00-6:00 PM) of three days within one calendar week. Two examiners performed replicate 3DIS volume measurements at each visit. Median coefficient of variation among replicate volume measurements was 1.7% (IQR 1.1% - 2.3%) for left legs and 2.2% (IQR 1.6% - 2.8%) for right legs. Median intraday volume increase was 3.0%. Range among daily volume measurements tended to be lower for afternoon measurements (median 2.25%, IQR 1.4%- 5.4%) than for morning measurements (median 3.0%, IQR 1.4% - 8.4%). CONCLUSIONS AND SIGNIFICANCE: Limb volume measurements by 3DIS are accurate and reproducible, and this technique is feasible for use in patients' homes. We have developed practical suggestions for optimal outcomes with 3DIS. Duplicate measurements should be performed and repeat assessments should be done at approximately the same time of day to minimize bias. Duplicate measures that vary by more than 8% should prompt review of scanning technique with a repeat measurement. With proper training and attention to technique, 3DIS can be a valuable tool for healthcare workers who work with lymphedema patients.


Assuntos
Filariose Linfática/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Imagem Tridimensional/métodos , Raios Infravermelhos , Adulto , Idoso , Extremidades/patologia , Feminino , Pessoal de Saúde/educação , Humanos , Perna (Membro)/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sri Lanka
10.
Bone Joint J ; 101-B(10): 1313-1320, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564158

RESUMO

AIMS: The aim of this study was to report the outcomes of patients who underwent definitive surgery for secondary chondrosarcomas arising from osteochondromas. PATIENTS AND METHODS: A total of 51 patients with secondary chondrosarcomas occurring from osteochondromas were reviewed. Median age was 36 years (interquartile range (IQR) 15 to 82). Median follow-up was 6.9 years (IQR 2.8 to 10.6). The pelvis was the most commonly affected site (59%). Histological grades were grade I in 35 (69%), grade II in 13 (25%), and grade III in three patients (6%). RESULTS: Preoperative biopsy histology correctly predicted the final histological grade in 27% of patients. The ten-year disease-specific survival (DSS) for all patients was 89.4%. Local recurrence occurred in 15 patients (29%), more commonly in pelvic tumours (37%) compared with limb tumours (19%). Four patients with pelvic tumours died from progression of local recurrence. No patient with limb tumours died of disease. Wide/radical margin was associated with improved local recurrence-free survival (p = 0.032) and local recurrence was associated with worse DSS (p = 0.005). CONCLUSION: We recommend that a secondary chondrosarcoma arising from osteochondroma of the pelvis is resected with wide/radical resection margins. The balance between the morbidity of surgery and risk of local recurrence needs to be considered in patients with limb secondary chondrosarcomas. Cite this article: Bone Joint J 2019;101-B:1313-1320.


Assuntos
Neoplasias Ósseas/patologia , Condrossarcoma/secundário , Recidiva Local de Neoplasia/mortalidade , Osteocondroma/patologia , Adulto , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/mortalidade , Condrossarcoma/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Extremidades/patologia , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Osteocondroma/diagnóstico por imagem , Osteocondroma/mortalidade , Osteocondroma/cirurgia , Ossos Pélvicos/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
11.
Biomed Pharmacother ; 118: 109347, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545273

RESUMO

λ-Carrageenan (Carr), a seaweed polysaccharide, is used as a proinflammatory agent in research. Betulinic acid (BA), a naturally occurring pentacyclic triterpenoid, exerts immunomodulatory, antioxidant, anti-inflammatory, antitumor, anti-malarial and anti-HIV effects. The aim of this study was to investigate whether BA exerts anti-inflammatory effect against Carr-induced paw edema in mice, and how BA could mediate the expression of inflammation-associated MAPK-COX-2-PGE2 signal pathway. BA pretreatment significantly reduced the inflammatory response to Carr-induced paw edema, especially at 4 h after injection. BA reduced the serum levels of pro-inflammatory cytokines, such as IL-1α, IL-1ß, IL-5, IL-6, GM-CSF, KC, MCP-1 and PGE2 in Carr-treated mice, and increased those of anti-inflammatory cytokines, such as IL-12. It also increased SOD, CAT and GSH-Px activities, and GSH content, and reduced MDA content in the liver of Carr-treated mice. Besides, BA reduced neutrophil infiltration in the basal and subcutaneous layers of the paw of Carr-treated mice, decreased the expression of COX-2 protein, and reduced the phosphorylation of JNK, p38 and ERK1/2. These results indicated that the protective effect of BA on Carr-induced paw edema might be due to its alleviation of inflammatory response and inhibition of oxidative stress, possibly by inhibiting MAPK-COX-2-PGE2 signaling pathway activation.


Assuntos
Anti-Inflamatórios/uso terapêutico , Edema/tratamento farmacológico , Extremidades/patologia , Triterpenos/uso terapêutico , Animais , Anti-Inflamatórios/farmacologia , Antioxidantes/metabolismo , Carragenina , Ciclo-Oxigenase 2/metabolismo , Citocinas/sangue , Dinoprostona/sangue , Edema/sangue , Edema/induzido quimicamente , Fígado/efeitos dos fármacos , Fígado/metabolismo , Masculino , Camundongos , Fosforilação/efeitos dos fármacos , Triterpenos/farmacologia
12.
BMC Cancer ; 19(1): 890, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492159

RESUMO

BACKGROUND: Soft-tissue sarcomas (STS) are rare malignant tumors those are resistant to chemotherapy. We have previously reported the 3-year follow-up result on the efficacy of perioperative chemotherapy with doxorubicin (DXR) and ifosfamide (IFM) for high-risk STS of the extremities (JCOG0304). In the present study, we analyzed the 10-year follow-up results of JCOG0304. METHODS: Patients with operable, high-risk STS (T2bN0M0, AJCC 6th edition) of the extremities were treated with 3 courses of preoperative and 2 courses of postoperative chemotherapy, which consisted of 60 mg/m2 of DXR plus 10 g/m2 of IFM over a 3-week interval. The primary study endpoint was progression-free survival (PFS) estimated by Kaplan-Meier methods. Prognostic factors were evaluated by univariable and multivariable Cox proportional hazards model. RESULTS: A total of 72 patients were enrolled between March 2004 and September 2008, with 70 of these patients being eligible. The median follow-up period was 10.0 years for all eligible patients. Local recurrence and distant metastasis were observed in 5 and 19 patients, respectively. The 10-year PFS was 65.7% (95% CI: 53.4-75.5%) with no PFS events being detected during the last 5 years of follow-up. The 10-year overall survival was 78.1% (95% CI: 66.3-86.2%). Secondary malignancy was detected in 6 patients. The subgroup analysis demonstrated that there was significant difference in survival with regard to primary tumor size. CONCLUSIONS: Only a few long-term results of clinical trials for perioperative chemotherapy treatment of STS have been reported. Our results demonstrate that the 10-year outcome of JCOG0304 for patients with operable, high-risk STS of the extremities was stable and remained favorable during the last 5 years of follow-up. TRIAL REGISTRATION: This trial was registered at the UMIN Clinical Trials Registry as C000000096 on August 30, 2005.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Extremidades/patologia , Sarcoma/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Doxorrubicina/administração & dosagem , Doxorrubicina/uso terapêutico , Esquema de Medicação , Feminino , Seguimentos , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/uso terapêutico , Japão , Masculino , Razão de Chances , Período Perioperatório , Sarcoma/mortalidade , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Taxa de Sobrevida , Resultado do Tratamento
13.
Biomed Pharmacother ; 118: 109351, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545244

RESUMO

PURPOSE: Little is known about the pharmacological effects of the phenolic compounds of Pennyroyal (Mentha pulegium). This Mediterranean aromatic plant, used as a gastronomic spice and as food preservative by the food industry has been studied mainly due to its essential oil antibacterial properties, composed primarily by monoterpenes. With this work, we aimed to evaluate the effects of a phenolic extract of pennyroyal in the impairment of inflammatory processes in Inflammatory Bowel Diseases (IBD) and in the potential inhibition of progression to colorectal cancer (CRC). METHODS: To that purpose, we evaluated the effect of pennyroyal extract administration in a model of TNBS-induced colitis in mice and further determined its effect on human colon carcinoma cell proliferation and invasion. RESULTS: The phenolic extract of pennyroyal exhibited antioxidant properties in in vitro assays and administration of the extract in a rat model of carrageenan-induced paw oedema led to significant anti-inflammatory effects. Further results evidenced a beneficial effect of the phenolic extract in the attenuation of experimental colitis and a potential antiproliferative effect on cultured colon cancer cells, effects not previously described, to our knowledge. A reduction in several markers of colon inflammation was observed following administration of the extract to colitis-induced mice, including functional and histological indicators. A successful inhibition of cancer cell invasion and proliferation was also observed in in vitro studies with HT-29 cells. Furthermore, the extract also led to a reduced expression of iNOS/COX-2 in the colon of colitis-induced mice, both being crucial mediators of intestinal inflammation. CONCLUSIONS: Taking into consideration the central role of inflammation in the pathophysiology of CRC and the recognised connection between inflammatory events and cancer, these results enlighten the relevance of the phenolic constituents of pennyroyal as important pharmacological sources in the investigation of new treatment options for patients with inflammatory bowel diseases.


Assuntos
Colo/lesões , Inflamação/tratamento farmacológico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Mentha pulegium/química , Fenóis/química , Extratos Vegetais/uso terapêutico , Animais , Antioxidantes/metabolismo , Biomarcadores/metabolismo , Movimento Celular/efeitos dos fármacos , Colo/patologia , Modelos Animais de Doenças , Edema/tratamento farmacológico , Edema/patologia , Extremidades/patologia , Flavonoides/análise , Células HT29 , Humanos , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Camundongos , Extratos Vegetais/administração & dosagem , Extratos Vegetais/farmacologia , Ratos Wistar
14.
An. bras. dermatol ; 94(4): 446-448, July-Aug. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1038296

RESUMO

Abstract: Necrolytic acral erythema is a distinct erythema that has been described as an extrahepatic manifestation of hepatitis C virus infection. Most reported cases have been in Africa, especially Egypt. We report the first case (to the best of our knowledge) of necrolytic acral erythema in a Chinese patient with HCV and HBV coinfection. We aim to increase awareness for recognizing this condition in the Chinese population.


Assuntos
Humanos , Masculino , Adulto , Hepatite C/complicações , Eritema/patologia , Eritema/virologia , Coinfecção/complicações , Hepatite B/complicações , China , Hepatite C/patologia , Extremidades/patologia , Coinfecção/patologia , Hepatite B/patologia , Necrose/virologia
16.
J Vet Intern Med ; 33(5): 2200-2208, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31294875

RESUMO

BACKGROUND: Metastasis of appendicular osteosarcoma is most common to the lungs and is generally considered a terminal event in dogs. Behavior and prognosis associated with cutaneous or subcutaneous metastases (CSM) is poorly defined. OBJECTIVE: Describe the population and gather prognostic information regarding appendicular osteosarcoma with CSM in dogs. ANIMALS: Twenty dogs with appendicular osteosarcoma and CSM. METHODS: Retrospective case series. Medical records were searched to identify dogs diagnosed with appendicular osteosarcoma that developed CSM. Demographic data, order of metastatic events, and CSM clinical features were evaluated. Kaplan-Meier survival curves were constructed and log-rank tests were used to compare survival between groups of dogs. RESULTS: In 19 dogs (95%), CSM was an incidental finding. Seventeen dogs (85%) developed pulmonary metastasis, and 1 dog (5%) developed bone metastasis. No other metastatic sites were detected before euthanasia. The median CSM-free interval and CSM survival time were 160 days (range: 0-542 days) and 55 days (range: 5-336 days), respectively. The median CSM survival time was significantly longer for dogs treated with surgery and chemotherapy (94 days) or chemotherapy only (64 days) than for dogs that did not receive these treatments (11 days) (P = .002 and P = .03, respectively). No other factors were associated with survival after diagnosis of CSM. CONCLUSION AND CLINICAL IMPORTANCE: The skin or subcutaneous tissue can be the first osteosarcoma metastatic site detected. After CSM diagnosis, the prognosis is grave with median survival <2 months. Although this finding could have been biased by case selection, treatment with surgery and chemotherapy may improve outcome.


Assuntos
Neoplasias Ósseas/veterinária , Doenças do Cão/patologia , Osteossarcoma/veterinária , Neoplasias Cutâneas/veterinária , Animais , Neoplasias Ósseas/terapia , Doenças do Cão/terapia , Cães , Extremidades/patologia , Extremidades/cirurgia , Feminino , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/veterinária , Masculino , Osteossarcoma/terapia , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/secundário , Análise de Sobrevida
17.
BMC Cancer ; 19(1): 657, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272407

RESUMO

BACKGROUND: The use of nomograms for prognostication of individual cancer patients has been recommended in order to facilitate precision medicine. However, models for patients with soft tissue sarcomas (STSs) are limited because of the rarity and heterogeneity of such cancers. In addition, no model has been developed on the basis of an Asian cohort. Here, we attempted to develop and internally validate nomograms for patients with localized STSs of the trunk and extremity. METHODS: This study retrospectively extracted 2827 patients with primary trunk and extremity STSs after definitive surgery using the Bone and Soft Tissue Tumor Registry, which is a nationwide sarcoma database in Japan. We developed three nomograms predicting the probability of local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and disease-specific survival (DSS) at 2 years after surgery, using the Cox multivariate model. The nomograms were internally validated for discrimination and calibration using bootstrap resampling and assessed for their clinical applicability by decision curve analysis (DCA). RESULTS: Local recurrence, distant metastasis and disease-specific death occurred in 241 patients (8.5%), 554 patients (19.6%) and 230 patients (8.1%), respectively. Histological diagnosis, grade and tumor size strongly influenced all three endpoints. The nomograms predicted accurately the probability of LRFS, DMFS and DSS (concordance index: 0.73, 0.70 and 0.75, respectively). DCA demonstrated that our nomograms had clinical applicability. CONCLUSION: We have developed the first nomograms for STSs based on an Asian cohort. These nomograms allowed accurate prediction of LRFS, DMFS and DSS at 2 years after definitive surgery, and can be used as a guide by clinicians for appropriate follow-up and counseling of patients.


Assuntos
Extremidades/patologia , Nomogramas , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Tronco/patologia , Adulto , Idoso , Confiabilidade dos Dados , Feminino , Seguimentos , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Recidiva Local de Neoplasia , Medicina de Precisão/métodos , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Carga Tumoral
18.
Vet Surg ; 48(8): 1372-1381, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31270830

RESUMO

OBJECTIVE: To report the feasibility of standing MRI (sMRI) and document the value of sMRI in surgical planning for surgical repair of limb fractures in the horse. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-one horses with preoperative sMRI. METHODS: Medical records were reviewed for fracture type, application of a polyester cast, sMRI sequences performed, technical variables, and image quality. Fracture geometry and concomitant lesions were compared between sMRI and radiography. The relative value of sMRI with regard to surgical planning was classified as minor (sMRI did not provide additional findings), intermediate (additional lesions found or slight modification to surgical plan), or major (sMRI led to significant alternations in surgical plan). RESULTS: Standing MRI provided good studies in all horses. Standing MRI was classified as having major relevance in 12 of 31 horses, intermediate relevance in 14 of 31 horses, and minor relevance in 5 of 31 horses. CONCLUSION: Preoperative sMRI produced good studies in all horses and influenced the surgical planning in the majority of fractures in this study. Application of a polyester cast seemed to improve comfort without appreciable loss of image quality. CLINICAL SIGNIFICANCE: Standing MRI can be considered as an adjunct to plan the repair of equine fractures, and a polyester cast does not impair image quality.


Assuntos
Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Doenças dos Cavalos/cirurgia , Cavalos/lesões , Imagem por Ressonância Magnética/veterinária , Animais , Moldes Cirúrgicos/classificação , Moldes Cirúrgicos/veterinária , Extremidades/diagnóstico por imagem , Extremidades/patologia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Doenças dos Cavalos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Radiografia/veterinária , Estudos Retrospectivos
19.
Pediatr Blood Cancer ; 66(11): e27935, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31339226

RESUMO

Spindle cell and sclerosing rhabdomyosarcoma (ssRMS) is a rare variant of rhabdomyosarcoma, which includes three distinct subtypes. In infants, these tumors are commonly associated with recurring fusions involving VGLL2 or NCOA2 and have a favorable prognosis. We present four cases of ssRMS and 16 additional cases from the literature, which show that these patients present with localized disease and have an excellent prognosis regardless of surgical margin or lack of radiation therapy. Molecularly defined spindle cell rhabdomyosarcoma in infants is likely a biologically distinct entity which may not require the aggressive multimodal treatment used for other subtypes of rhabdomyosarcoma.


Assuntos
Rabdomiossarcoma Embrionário/congênito , Neoplasias de Tecidos Moles/congênito , Amputação , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Extremidades/patologia , Feminino , Doenças do Pé/congênito , Doenças do Pé/tratamento farmacológico , Doenças do Pé/genética , Doenças do Pé/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/tratamento farmacológico , Doenças do Prematuro/genética , Doenças do Prematuro/cirurgia , Masculino , Proteínas de Fusão Oncogênica/genética , Indução de Remissão , Rabdomiossarcoma Embrionário/tratamento farmacológico , Rabdomiossarcoma Embrionário/genética , Rabdomiossarcoma Embrionário/cirurgia , Neoplasias de Tecidos Moles/tratamento farmacológico , Neoplasias de Tecidos Moles/genética , Neoplasias de Tecidos Moles/cirurgia , Coxa da Perna , Neoplasias Torácicas/congênito , Neoplasias Torácicas/tratamento farmacológico , Neoplasias Torácicas/genética , Neoplasias Torácicas/cirurgia , Parede Torácica/patologia , Vincristina/administração & dosagem
20.
Ann Surg Oncol ; 26(11): 3542-3549, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342400

RESUMO

BACKGROUND: The role of neoadjuvant chemotherapy (NCT) for high-risk soft tissue sarcoma (STS) is questioned. This study aimed to define which patients may experience a survival advantage with NCT. METHODS: All the patients from the U.S. Sarcoma Collaborative database (2000-2016) who underwent curative-intent resection of high-grade, primary truncal/extremity STS size 5 cm or larger were included in this study. The primary end points were recurrence-free survival (RFS) and overall survival (OS). RESULTS: Of the 4153 patients, 770 were included in the study. The median tumor size was 10 cm, and 669 of the patients (87%) had extremity tumors. The most common histology was undifferentiated pleomorphic sarcoma (UPS), found in 42% of the patients. Of the 770 patients, 216 (28%) received NCT. The patients who received NCT had deeper, larger tumors (p < 0.001). Of the patients with tumors 5 cm or larger and 8 cm or larger, NCT was not associated with improved RFS or OS. However for the patients with tumors 10 cm or larger, NCT was associated with improved 5-year RFS (51% vs 40%; p = 0.053) and 5-year OS (58% vs 47%; p = 0.043). By location, the patients with extremity tumors 10 cm or larger but not truncal tumors had improved 5-yearr RFS (54% vs 42%; p = 0.042) and 5-year OS (61% vs 47%; p = 0.015) with NCT. According to histology, no subtype had improved RFS or OS with NCT, although the patients with UPS had a trend toward improved 5-year RFS (56% vs 42%; p = 0.092) and 5-year OS (66% vs 52%; p = 0.103) with NCT. CONCLUSION: For the patients with high-grade STS, NCT was associated with improved RFS and OS when tumors were 10 cm or larger and located in the extremity. However, no histiotype-specific advantage was identified. Future studies assessing the efficacy of NCT may consider focusing on these patients, with added focus on histology-specific strategies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante/mortalidade , Extremidades/patologia , Terapia Neoadjuvante/mortalidade , Recidiva Local de Neoplasia/mortalidade , Sarcoma/mortalidade , Tronco/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/tratamento farmacológico , Sarcoma/patologia , Taxa de Sobrevida , Estados Unidos
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