Preservação dos ovários em cirurgia radical para câncer do colo uterino

OBJETIVO: avaliar a função ovariana em pacientes com câncer do colo uterino, que se submeteram a histerectomia radical com preservação dos ovários. MÉTODOS: foram analisadas retrospectivamente pacientes com câncer do colo uterino, submetidas a histerectomia radical com preservação dos ovários na Clínica Ginecológica do Hospital São Marcos-SPCC, de abril de 1998 a outubro de 2001, com avaliação dos sintomas de privação estrogênica (fogachos, vagina seca) e mensuração dos níveis de FSH pós-operatórios. Os dados foram analisados pelo teste de Pearson. RESULTADOS: os níveis de FSH foram mensurados em 42 pacientes; destas, 33 (78,5%) apresentaram níveis normais de FSH no pós-operatório (menores que 30 mU/mL); os valores variaram entre 1,2 e 132,44 mU/mL (mediana de 21,05 mU/mL). Das nove pacientes com níveis elevados de FSH, cinco (55,6%) haviam sido submetidas a radioterapia pós-operatória (p<0,0001). Não houve associação entre a idade das pacientes e os níveis de FSH (p=0,33). Cistos ovarianos funcionais ocorreram em quatro pacientes (7,7%). Uma paciente apresentou recidiva da lesão na cúpula vaginal e metástase para o couro cabeludo, evoluindo para óbito. CONCLUSÃO: observou-se preservação da função ovariana em 78,5% das pacientes. A transposição ovariana foi inadequada para preservar sua função em pacientes submetidas à radioterapia pós-operatória. Não se observou associação entre idade e níveis de FSH no pós-operatório.

Quimioterapia neoadjuvante seguida de cirurgia radical em paciente grávida com câncer de colo de útero: relato de caso e revisão de literatura

Em pacientes grávidas portadoras de câncer de colo de útero (CCU), as opções terapêuticas dependem da idade gestacional, do estágio clínico e do desejo da paciente. Alguns autores relataram casos de quimioterapia neoadjuvante seguidos de cirurgia radical nessas pacientes. O objetivo deste artigo foi revisitar o assunto, adicionar um novo caso e revisar a literatura. Relatamos o caso de uma mulher de 30 anos, na 24ª semana de gestação, que teve diagnóstico de câncer de colo de útero (carcinoma escamoso grau II), estágio IIB (Federação Internacional de Ginecologia e Obstetrícia - FIGO). Nulípara, a paciente recusou a interrupção da gravidez. Após meticuloso esclarecimento, a paciente aceitou tratamento com quimioterapia neoadjuvante com cisplatina 75 mg/m² e vincristina 1 mg/m², além de posterior avaliação de cirurgia radical e parto cirúrgico concomitantes. Quatros ciclos completos de quimioterapia foram administrados sem atrasos ou efeitos adversos importantes. Poucos dias antes da data programada para a cirurgia, a paciente foi admitida em trabalho de parto na 37ª semana de gestação. Devido à resposta clínica completa do tumor, a equipe obstétrica optou por monitorar o trabalho de parto, e a paciente deu à luz um recém-nascido de 2.450 g, sem intercorrências. A cirurgia radical foi realizada três dias após o parto, e a análise histopatológica revelou carcinoma confinado ao colo sem envolvimento linfonodal. Mãe e filho se encontram em bom estado geral 12 meses após o parto. Quimioterapia baseada em cisplatina durante o segundo ou terceiro trimestre da gravidez parece ser uma opção para as pacientes que não desejam a interrupção da gravidez enquanto se aguarda a maturidade fetal. Entretanto, estudos adicionais são necessários para confirmar o prognóstico e a segurança dos recém-nascidos e das pacientes.

Nonspecific blockade of vascular free radical signals by methylated arginine analogues

Methylated arginine analogues are often used as probes of the effect of nitric oxide; however, their specificity is unclear and seems to be frequently overestimated. This study analyzed the effects of NG-methyl-L-arginine (L-NMMA) on the endothelium-dependent release of vascular superoxide radicals triggered by increased flow. Plasma ascorbyl radical signals measured by direct electron paramagnetic resonance spectroscopy in 25 rabbits increased by 3.8 ± 0.7 nmol/l vs baseline (28.7 ± 1.4 nmol/l, P<0.001) in response to papaverine-induced flow increases of 121 ± 12%. In contrast, after similar papaverine-induced flow increases simultaneously with L-NMMA infusions, ascorbyl levels were not significantly changed compared to baseline. Similar results were obtained in isolated rabbit aortas perfused ex vivo with the spin trap a-phenyl-N-tert-butylnitrone (N = 22). However, in both preparations, this complete blockade was not reversed by co-infusion of excess L-arginine and was also obtained by N-methyl-D-arginine, thus indicating that it is not related to nitric oxide synthase. L-arginine alone was ineffective, as previously demonstrated for NG-methyl-L-arginine ester (L-NAME). In vitro, neither L-arginine nor its analogues scavenged superoxide radicals. This nonspecific activity of methylated arginine analogues underscores the need for careful controls in order to assess nitric oxide effects, particularly those related to interactions with active oxygen species.

Antioxidant and free radical scavenging effects in extracts of the medicinal herb Achyrocline satureioides (Lam.) DC. ("marcela")

Achyrocline satureioides (Lam.) DC. (Compositae) is a medicinal herb used in Argentina, Uruguay, Brazil and Paraguay for its choleretic, antispasmodic and hepatoprotective properties. The presence of the flavonoid quercetin and its derivatives, and of different phenolic acids such as caffeic, chlorogenic and isochlorogenic acids in the aerial parts of this plant has led us to study the antioxidant activity of its extracts using different bioassays. The inhibition of luminol-enhanced chemiluminescence by the aqueous and methanolic extracts was used to show that their total reactive antioxidant potential index (TRAP; in µM Trolox equivalents) was 91.0 ± 15.4 and 128.1 ± 20.1 µM, respectively, while the total antioxidant reactivity index (TAR) was calculated to be 1537 ± 148 and 1910 ± 171 µM. Only the methanolic extract was capable of reducing iron (II)-dependent DNA damage. Lipid peroxidation was assessed by two different methods. The aqueous extract reduced hydroperoxide-initiated chemiluminescence in rat liver homogenates at all concentrations in a dose-dependent manner, with a calculated IC50 = 225 µg/ml, while the methanolic extract was only effective at higher concentrations (100 and 1000 µg/ml). Both aqueous and methanolic extracts were capable of reducing the production of thiobarbituric acid reactive substances (TBARS) in rat liver homogenates, with an IC50 >1000 µg/ml. The results obtained suggest that the extracts of A. satureioides possess significant free radical scavenging and antioxidant activity in vitro, a fact that should encourage future in vivo studies.

Lipid peroxidation and total radical-trapping potential of the lungs of rats submitted to chronic and sub-chronic stress

Exposure to stress induces a cluster of physiological and behavioral changes in an effort to maintain the homeostasis of the organism. Long-term exposure to stress, however, has detrimental effects on several cell functions such as the impairment of antioxidant defenses leading to oxidative damage. Oxidative stress is a central feature of many diseases. The lungs are particularly susceptible to lesions by free radicals and pulmonary antioxidant defenses are extensively distributed and include both enzymatic and non-enzymatic systems. The aim of the present study was to determine lipid peroxidation and total radical-trapping potential (TRAP) changes in lungs of rats submitted to different models of chronic stress. Adult male Wistar rats weighing 180-230 g were submitted to different stressors (variable stress, N = 7) or repeated restraint stress for 15 (N = 10) or 40 days (N = 6) and compared to control groups (N = 10 each). Lipid peroxidation levels were assessed by thiobarbituric acid reactive substances (TBARS), and TRAP was measured by the decrease in luminescence using the 2-2'-azo-bis(2-amidinopropane)-luminol system. Chronic variable stress induced a 51% increase in oxidative stress in lungs (control group: 0.037 ± 0.002; variable stress: 0.056 ± 0.007, P < 0.01). No difference in TBARS was observed after chronic restraint stress, but a significant 57% increase in TRAP was presented by the group repeatedly restrained for 15 days (control group: 2.48 ± 0.42; stressed: 3.65 ± 0.16, P < 0.05). We conclude that different stressors induce different effects on the oxidative status of the organism.

Protective effect of N-acetylcysteine against oxygen radical-mediated coronary artery injury

The present study investigated the protective effect of N-acetylcysteine (NAC) against oxygen radical-mediated coronary artery injury. Vascular contraction and relaxation were determined in canine coronary arteries immersed in Kreb's solution (95% O2-5% CO2), incubated or not with NAC (10 mM), and exposed to free radicals (FR) generated by xanthine oxidase (100 mU/ml) plus xanthine (0.1 mM). Rings not exposed to FR or NAC were used as controls. The arteries were contracted with 2.5 µM prostaglandin F2alpha. Subsequently, concentration-response curves for acetylcholine, calcium ionophore and sodium fluoride were obtained in the presence of 20 µM indomethacin. Concentration-response curves for bradykinin, calcium ionophore, sodium nitroprusside, and pinacidil were obtained in the presence of indomethacin plus Nomega-nitro-L-arginine (0.2 mM). The oxidative stress reduced the vascular contraction of arteries not exposed to NAC (3.93 ± 3.42 g), compared to control (8.56 ± 3.16 g) and to NAC group (9.07 ± 4.0 g). Additionally, in arteries not exposed to NAC the endothelium-dependent nitric oxide (NO)-dependent relaxation promoted by acetylcholine (1 nM to 10 µM) was also reduced (maximal relaxation of 52.1 ± 43.2%), compared to control (100%) and NAC group (97.0 ± 4.3%), as well as the NO/cyclooxygenase-independent receptor-dependent relaxation provoked by bradykinin (1 nM to 10 µM; maximal relaxation of 20.0 ± 21.2%), compared to control (100%) and NAC group (70.8 ± 20.0%). The endothelium-independent relaxation elicited by sodium nitroprusside (1 nM to 1 µM) and pinacidil (1 nM to 10 µM) was not affected. In conclusion, the vascular dysfunction caused by the oxidative stress, expressed as reduction of the endothelium-dependent relaxation and of the vascular smooth muscle contraction, was prevented by NAC.

An extract of Polygonum multiflorum protects against free radical damage induced by ultraviolet B irradiation of the skin

Over the last decades, the incidence of ultraviolet B (UVB)-related skin problems has been increasing. Damages induced by UVB radiation are related to mutations that occur as a result of direct DNA damage and/or the production of reactive oxygen species. We investigated the anti-oxidant effects of a Polygonum multiflorum thumb extract against skin damage induced by UVB irradiation. Female SKH-1 hairless mice were divided into three groups: control (N = 7), distilled water- (N = 10), and P. multiflorum extract-treated (PM, N = 10) groups. The PM (10 g) was extracted with 100 mL distilled water, cryo-dried and 9.8 g was obtained. The animals received a topical application of 500 µL distilled water or PM extract (1, 2, 4, 8, and 16%, w/v, dissolved in distilled water) for 30 min after UVB irradiation (wavelength 280-320 nm, 300 mJ/cm²; 3 min) of the dorsal kin for 14 days, and skin immunohistochemistry and Cu,Zn-superoxide dismutase (SOD1) activity were determined. SOD1 immunoreactivity, its protein levels and activities in the skin were significantly reduced by 70% in the distilled water-treated group after UVB irradiation compared to control. However, in the PM extract-treated groups, SOD1 immunoreactivity and its protein and activity levels increased in a dose-dependent manner (1-16%, w/v, PM extract) compared to the distilled water-treated group. SOD1 protein levels and activities in the groups treated with 8 and 16%, w/v, PM extract recovered to 80-90% of the control group levels after UVB. These results suggest that PM extract strongly inhibits the destruction of SOD1 by UV radiation and probably contains anti-skin photoaging agents.

Multiple factor analysis of metachronous upper urinary tract transitional cell carcinoma after radical cystectomy

Transitional cell carcinoma (TCC) of the urothelium is often multifocal and subsequent tumors may occur anywhere in the urinary tract after the treatment of a primary carcinoma. Patients initially presenting a bladder cancer are at significant risk of developing metachronous tumors in the upper urinary tract (UUT). We evaluated the prognostic factors of primary invasive bladder cancer that may predict a metachronous UUT TCC after radical cystectomy. The records of 476 patients who underwent radical cystectomy for primary invasive bladder TCC from 1989 to 2001 were reviewed retrospectively. The prognostic factors of UUT TCC were determined by multivariate analysis using the COX proportional hazards regression model. Kaplan-Meier analysis was also used to assess the variable incidence of UUT TCC according to different risk factors. Twenty-two patients (4.6%). developed metachronous UUT TCC. Multiplicity, prostatic urethral involvement by the bladder cancer and the associated carcinoma in situ (CIS) were significant and independent factors affecting the occurrence of metachronous UUT TCC (P = 0.0425, 0.0082, and 0.0006, respectively). These results were supported, to some extent, by analysis of the UUT TCC disease-free rate by the Kaplan-Meier method, whereby patients with prostatic urethral involvement or with associated CIS demonstrated a significantly lower metachronous UUT TCC disease-free rate than patients without prostatic urethral involvement or without associated CIS (log-rank test, P = 0.0116 and 0.0075, respectively). Multiple tumors, prostatic urethral involvement and associated CIS were risk factors for metachronous UUT TCC, a conclusion that may be useful for designing follow-up strategies for primary invasive bladder cancer after radical cystectomy.

Inhibition of cyclooxygenase activity by standardized hydroalcoholic extracts of four Asteraceae species from the Argentine Puna

We determined the anti-inflammatory activity of standardized extracts of four medicinal plant species (Baccharis incarum, B. boliviensis, Chuquiraga atacamensis, Parastrephia lucida) that grow in the Argentine Puna (3800 m above sea level) and that are used to reduce oxidative stress and alleviate gout and arthritic pain. The extracts of plant aerial parts were standardized in terms of total phenolic compounds and flavone/flavanone content and free radical scavenging activity. All extracts showed high phenolic compound concentration (0.5-1.6 mg/mL), mainly flavones and flavonols (0.1-0.8 mg/mL). The extracts showed hydrogen donating ability (DPPH and ABTS) and reactive oxygen species scavenging activity (O2●-, OH-, H2O2). The ability of the extracts to inhibit cyclooxygenase enzymes (COX-1 and COX-2) was determined by calculating percent inhibition of PGE2 production measured by enzyme immunoassay. All extracts inhibited both enzymes with IC50 values of 2.0 to 16.7 µg/mL. The anti-inflammatory activity of B. incarum and C. atacamensis extracts was higher than that of B. boliviensis and P. lucida. The IC50 values obtained for indomethacin were 0.11 and 0.78 µM for COX-1 and COX-2, respectively. The present results are consistent with the anecdotal use of these species in phytotherapic preparations.

Actividad antioxidante de pigmentos antociánicos

Los antocianos son colorantes naturales pertenecientes al grupo de los flavonoides. Están presentes en casi todas las plantas y en todas sus partes, sobretodo en flores y frutos (particularmente en bayas). Para determinar la actividad antioxidante de los pigmentos antociánicos se ha utilizado el radical ABTS·+ formado tras la reacción de 2,2'azinobis-(3-etilbenzotiazolin 6-ácido sulfónico) (ABTS) con persulfato potásico, incubados a temperatura ambiente y durante 16 horas. Se determinó la capacidad antioxidante de cinco antocianos puros: delfinidina, cianidina, peonidina, pelargonidina y malvidina todos ellos glucosilados en el C-3 del anillo C con excepción de la delfinidina. De los antocianos ensayados, delfinidina y cianidina 3-glucósido presentan mayor actividad antioxidante, 2 veces mas que el Trolox (antioxidante sintético de referencia). Los demás antocianos tienen menor actividad pero potencial equiparable al Trolox. Por lo tanto, además de las características colorantes, los antocianos poseen potente propiedad antioxidante.

Índice de polifenóis, antocianinas totais e atividade antioxidante de um sistema modelo de geléia de uvas

Antocianinas são pigmentos fenólicos com potencial para substituição dos corantes artificiais vermelhos; porém, estes se apresentam instáveis frente ao processamento de alimentos, sendo a temperatura um dos principais fatores envolvidos na degradação da cor destes pigmentos. O objetivo deste trabalho foi avaliar a concentração de compostos fenólicos e a capacidade antioxidante de um sistema modelo de geléia de uvas (SMG) Isabel (Vitis labrusca) e Refosco (Vitis vinifera L.) elaborado a 45 °C, utilizando como agente espessante uma mistura de gomas xantana e locusta. Nos SMGs elaborados, avaliou-se a estabilidade dos pigmentos antociânicos e determinou-se polifenóis totais (IPT), antocianinas totais (AT). A atividade antioxidante foi medida utilizando os métodos de captura de radicais estáveis como o radical DPPH (2,2-difenil-1-picril-hidrazila) e o radical ABTS (2,2’-azino-bis-(3-etilbenzotiazolina-6-ácido sulfônico)). Avaliou-se também a concentração de AT nos extratos de uvas utilizados na elaboração do SMG. Um alto coeficiente de correlação foi encontrado entre AT e IPT dos SMGs e a atividade antioxidante. Os melhores resultados quanto à concentração de IPT, AT e em relação à atividade antioxidante foram obtidos para o SMG elaborado com uva Refosco. O método utilizado para a elaboração dos SMGs foi efetivo na preservação da cor antocianinas e das propriedades antioxidantes dos compostos fenólicos totais avaliados.

Evaluation of antioxidant activity of agro-industrial waste of acerola (Malpighia emarginata D.C.) fruit extracts

This study was carried out to evaluate the antioxidant capacity of the agro-industrial waste from acerola. Hydroacetone, hydroethanolic, and hydromethanolic extracts were obtained using the sequential extraction process, and they were screened for their free radical DPPH• (1,1-diphenyl-2-picrilhidrazil) and ABTS•+ (2,2'-azino-bis-(3-etilbenzotiazolin 6-sulfonic acid) scavenging activity and their effect on the linoleic acid peroxidation by the ferric thiocyanate method. Soybean oil with the addition of the extracts (200 ppm) was submitted to Schaal oven test (60 °C, 28 days), in which the samples were analyzed for peroxide value and conjugated dienes. Hydroethanolic and hydromethanolic extracts exhibited good DPPH scavenging activity (low value of EC50 and TEC50 and high value of AE), good ABTS scavenging capacity (1445.1 and 1145.5 µMol TEAC.g-1, respectively), and high percentage inhibition of peroxidation of linoleic acid (96.12 and 91.84%, respectively) and showed the ability to retard the formation of peroxides and conjugated dienes.

Phenols, flavonoids and antioxidant activity of aqueous and methanolic extracts of propolis (Apis mellifera L.) from Algarve, South Portugal

Propolis is a resinous substance collected by honeybees to seal honeycomb, which has been used in folk medicine due to its antimicrobial and antioxidant properties. In the present study, water and methanol were used to extract phenols and flavonoids from propolis collected in thirteen different areas in the Algarve region during the winter and spring. The ABTS•+, DPPH•, and O2•- scavenging capacity, and metal chelating activity were also evaluated in the propolis samples. Methanol was more effective than water in extracting total phenols (2.93-8.76 mg/mL) (0.93-2.81 mg/mL). Flavones and flavonols were also better extracted with methanol (1.28-2.76 mg/mL) than with water (0.031-0.019 mg/mL). The free radical scavenging activity, ABTS (IC50=0.006-0.036 mg/mL), DPPH (IC50=0.007-0.069 mg/mL) and superoxide (IC50=0.001-0.053 mg/mL), of the samples was also higher in methanolic extracts. The capacity for chelating metal ions was higher in aqueous extracts (41.11-82.35%) than in the methanolic ones (4.33-29.68%). Propolis from three locations of Algarve region were richer in phenols and had better capacity for scavenging free ABTS and DPPH radicals than the remaining samples. These places are part of a specific zone of Algarve known as Barrocal.