Laparoscopy in uterine cervical cancer. Current state and literature review

Cervical cancer remains the most frequent gynecological tumor in Brazil and other developing countries. Minimally invasive techniques, especially laparoscopy, have been increasingly employed in such tumors. This article aims to describe the main applications of laparoscopy in the treatment and staging of cervical cancer. In the early stages, it is possible to provide a fertility-preserving surgery in the form of radical trachelectomy and, in a study protocol, the function-preserving surgery, avoiding parametrectomy and the associated morbidity. A fully laparoscopic radical hysterectomy is fairly standard in the literature and has the tendency to become the standard of care in early cases, for patients who want to bear no more children. In advanced stages, minimally invasive surgery can offer ovarian transposition, with intent to prevent actinic castration, without upsetting the time for the start of radiotherapy and chemotherapy. Staging laparoscopic surgery, including pelvic and para-aortic lymphadenectomy, has been the subject of studies, since it has the potential to modify the extension of radiotherapy depending on the extent of lymph node spread.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer

Objective: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. Methods: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic / tumoral Results: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. Conclusion: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Criteria for prediction of metastatic axillary lymph nodes in early-stage breast cancer

PURPOSE: To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors. METHODS: A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis. RESULTS: Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size. CONCLUSION: The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.

Vascularização arterial da região do nó sinoatrial em corações suínos: origem, distribuição e quantificação

O nó sinoatrial, por se encontrar topograficamente instalado como componente inicial do sistema de condução, é responsável pela geração dos impulsos nervosos determinantes da contração cardíaca. Estudos relacionados à morfologia do nó, visando conhecer a origem, trajeto e distribuição dos vasos neste tecido são conhecidos, contudo, no que diz respeito a estes aspectos e aos dados quantitativos da irrigação nodal, no que se refere ao comportamento vascular arterial e a densidade vascular arterial desta região, a literatura é escassa. Com este objetivo foram utilizados 30 corações de suínos SRD, sendo 27 injetados com resina vinílica corada, para análise da origem e trajeto da ANSA (artéria do nó sinoatrial) e 3 corações injetados com solução aquosa de carvão coloidal (tinta nanquim) para proceder à análise estereológica. As artérias atriais originaram-se tanto da artéria coronária direita quanto da esquerda, com predominância da primeira (66,66% e 33,33%, respectivamente). Quando originada da coronária direita, a irrigação ocorreu pelo ramo AADAM (artéria atrial direita cranial medial) em 14 casos e pelos ramos AADAI (artéria atrial direita cranial medial) em 2 casos e AADAL (artéria atrial direita cranial lateral) em 2 casos. Em 9 casos (33,33%) originou-se pela artéria coronária esquerda: quatro pelo ramo AASPL (artéria atrial esquerda caudal lateral), dois pelo ramo AASAI (artéria atrial esquerda cranial intermédia) e três pelo ramo AASAM (artéria atrial esquerda cranial medial). Anastomoses interarteriais, com participação dos vasos responsáveis pela irrigação do território do nó sinoatrial foram observadas na maioria dos casos (25 corações). O Volume do órgão ou Volume Referência (V(ref)) foi de 35,32x10(4)µm³. Para as variáveis estereológicas analisadas, a estimação da densidade de comprimento do vaso (Lv) foi de 766; o comprimento do vaso (L) - mm - foi de 27,06x10(5)µm; a densidade de superfície de área (Sv) foi de 182 e a superfície de área (S) - mm² - foi de 64,3x10(6)µm². A estimação da densidade numérica vascular (Nv(vasc)), quantidade de vasos por unidade de volume (cm³), foi de 2,19 10-5 e o número total de vasos no órgão (N(vasc)), estimado pelo método dissector físico em combinação com a estimativa do número de Euler (Xv), foi de 773,6832 x10-2. A elevada densidade vascular e do número total de vasos na região do nó sinoatrial de suínos sugere a existência de uma complexa e densa rede vascular perinodal, ratificando a importância deste marca-passo pelo seu suprimento sangüíneo.

Participação da excreção renal de cálcio, fósforo, sódio e potássio na homeostase em cães sadios e cães com doença renal crônica

Na doença renal crônica (DRC) a manutenção da homeostase de água e sódio é o primeiro problema a ser contornado pelo organismo e com o agravamento das lesões renais surgem outros problemas graves relacionados à homeostase de cálcio e fósforo. O presente estudo tem por escopo avaliar a excreção renal de cálcio, fósforo, sódio e potássio, e o perfil sérico destes eletrólitos em cães normais e em cães com DRC naturalmente adquirida. Foram avaliados três grupos de cães adultos, machos ou fêmeas, de raças variadas. Animais normais compuseram o grupo controle (G1) e os cães com DRC foram distribuídos em dois grupos de acordo com os estágios de comprometimento da função renal (G2 e G3, respectivamente, estágios 1-2 e estágios 3-4, descritos pela IRIS 2006 staging CKD). Os cães do G3 apresentaram aumento das concentrações séricas de cálcio ionizado e fósforo, além de diminuição da concentração sérica de sódio. Quanto à excreção renal dos eletrólitos analisados, os animais dos grupos G1 e G2 apresentaram diminuição de carga filtrada e aumento de excreção fracionada, mas as excreções urinárias não variaram significativamente. Os resultados são indicativos de que os rins de cães com DRC podem manter a excreção urinária dos eletrólitos em valores se melhantes aos dos normais. O mecanismo envolve aumento da excreção fracionada na medida em que haja diminuição da filtração glomerular. Esse processo de compensação, entretanto, pode perder a eficiência nos estágios mais avançados da enfermidade no que se refere à manutenção das concentrações séricas de fósforo e sódio.

Sinningia allagophylla(Gesneriaceae): in vitro cultivation of a native plant of the Brazilian cerrado

We used axillary buds as initial explants for hormone interaction studies required for in vitro cultivation of S. allagophylla. Callus production was achieved on gelled Murashige & Skoog medium (MS) supplemented with indole-3-acetic acid (IAA= 0.1 and 0.5 mg.l­1 alone or combined with 6 benzylaminopurine) (BA= 0.01 and 0.1 mg.l-1). A hormone balance between IAA and BA that would encourage shoot bud development was not found. Nodal segments from axenic cultures grown in the presence of cytokinin (0.1 mg.1­1 of BA) without any auxin on MS medium with half-strength macronutrients were used as a standard explant source for subsequent experiments on optimum mineral culture media composition for S. allagophylla in vitro cultivation. We found that explants kept in vitro on gelled Gamborg et al. (B5) mineral composition culture medium showed better shoot and specially root growth than on MS medium. Comparisons of the ammonium and nitrate ratios of MS and B5 media indicate that B5 medium has a substantial reduced ammonium ion when compared to MS medium, as well as a lower total nitrogen level. The growth response pattern obtained in vitro may be evidence of the adaptation of this species to soils of poor mineral composition as found in the Brazilian cerrado, as well as an indication that nitrogen levels play a key role for S. allagophylla growth.

Development, structure and distribution of colleters in Mandevilla illustris and M. velutina (Apocynaceae)

Colleters of Mandevilla illustris and M. velutina are present on the cotyledons, shoot apices, mature leaves and on the nodal region, where they are interpetiolar and intrapetiolar. In M. velutina there are two colleters on the adaxial basal part of the leaf blade, and in M. illustris, this number varies. The differentiation of the colleters occurs in the early stages of leaf development. When colleters are mature, they consist of a long head on a short stalk. The central core of the colleter is made up of parenchymatous cells that may exhibit phenolic compounds and is surrounded by radially elongated epithelial cells. The foliar and intrapetiolar colleters can exhibit vascularization. The colleters produce a translucient sticky substance that reacts positively to polysaccharides and, before senescence, they produce lipophilic substances. The Mandevilla colleters data can give support to the taxonomy and phylogeny of the Apocynaceae.

In vitro culture of Phyllanthus stipulatus (Euphorbiaceae)

An efficient micropropagation protocol was developed for the medicinal plant Phyllanthus stipulatus (Euphorbiaceae) using nodal segments for axillary shoot proliferation. Maximum multiplication rates (8-9 shoots per explant) was achieved on MS media supplemented with either 2.5-5.0 muM IBA. The best basal media for axillary shoot proliferation when 0.62 muM BA was supplemented were MS, MS/2 and AR (4-5 shoots per explant). Rooting was achieved with 100% of the microshoots on MS medium without growth regulators. Regenerated plants were successfully acclimatized and about 88% of plantlets survived under ex vitro conditions. Flowering was observed in 81% of the ex vitro grown plantlets after 12 weeks of acclimatization. High frequency callus initiation and growth was achieved when nodal segment explants were inoculated either in the vertical position, in the light on MS medium supplemented with 5.0 muM NAA or horizontally oriented, in the dark on MS supplemented with 5.0 muM NAA or 1.25-5.0 muM BA or 2iP. Root cultures were successfully established on MS medium containing 1.1 muM NAA. The optimized micropropagation, callus and root culture protocols offer the possibility to use cell/organ culture techniques for vegetative propagation and secondary metabolism studies.

Ceramium nitens (Ceramiaceae, Rhodophyta), an uncommon species from Brazil

Morphological studies on Ceramium nitens (C. Agardh) J. Agardh, a completely corticated species, were carried out based on specimens rediscovered in Brazil fifty years after its first record. Its occurrence in Brazil was considered doubtful since it had been collected only once since 1945. Ceramium nitens can be recognized by having axial cells entirely covered by cortical cells, except for the cells near the apex, obscuring the nodal and internodal banding thalli, characteristic of most Ceramium species. In this paper the occurrence of Ceramium nitens in Brazil is confirmed and its vegetative and tetrasporangial structures are described in detail and their implications for the taxonomy of the genera Ceramium, Centroceras and Corallophila are discussed. Brief comments on the geographic distribution of C. nitens are also included.

Diallel cross analysis for young plants of brachytic maize (Zea mays L.) varieties

Six brachytic maize varieties were crossed in a diallel mating scheme. Both varieties and crosses were grown hydroponically in a greenhouse, in randomized complete blocks with three replications in two seasons. Four brachytic double cross hybrids were used as checks. Twenty-eight days after planting, data for eight traits were taken for weights of the total plant (TPW), top plant (TOW), total roots (TRW), seminal roots (SRW), and nodal roots (NRW) and number of total roots (TRN), seminal roots (SRN), and nodal roots (NRN). Ten plants were measured in each plot and all the analyses were accomplished with plot means. In the diallel cross the top plant contributed 57.6% of the total plant weight, for seminal roots 15.4%, and for nodal roots 27.0%. Root number distribution was 36.7% seminal roots and 63.3% nodal roots. Approximately the same ratios were observed in the checks. The average heterosis effects were nonsignificant for all traits; the other components of heterosis (variety and specific heterosis) also were not important sources of variation in young plants. The overall results suggest that nonadditive gene action is not an important source of variation for the plant and root system of young plants. The positive correlation coefficients for combinations of traits indicated that they are under the control of a polygenic system

Los newagers: el efecto colibrí. Artífices de menús especializados, tejedores de circuitos en la red, y polinizadores de culturas híbridas

En este artículo se describe la trayectoria de búsqueda espiritual de un agente nodal en la red espiritual alternativa comúnmente conocida como New Age para atender el impacto de su trayectoria en la hibridación de una espiritualidad neoindia. Se proponen tres procesos a tenerse en cuenta para una metodología del estudio del impacto de hibridación cultural que genera el New Age: 1) Su condición de diseñador de menús creyentes individualizados hechos con retazos de distintas tradiciones religiosas (Champion y Hervieu-Lèger 1990); 2) su agencia como “agente nodal” para tejer articulaciones, alianzas y conexiones en la red: entre otros agentes nodos, entre diversos circuitos y otros campos sociales especializados; y 3) su competencia de “polinizador” (Soares 2009) de culturas y religiones. El argumento de este trabajo destaca que los buscadores espirituales en su andar no sólo recogen fragmentos culturales de distintas tradiciones para armar menús personalizados de creencias, sino que además son transmisores de significados que contribuyen a hibridar las culturas por donde van pasando. Muchas de las cuales coinciden con comunidades étnicas valoradas por su relación con la naturaleza, su ancestralidad y su exotismo a los ojos de los occidentales.

Amplification of 9q34 in childhood adrenocortical tumors: a specific feature unrelated to ethnic origin or living conditions

Adrenocortical tumors (ACT) in children under 15 years of age exhibit some clinical and biological features distinct from ACT in adults. Cell proliferation, hypertrophy and cell death in adrenal cortex during the last months of gestation and the immediate postnatal period seem to be critical for the origin of ACT in children. Studies with large numbers of patients with childhood ACT have indicated a median age at diagnosis of about 4 years. In our institution, the median age was 3 years and 5 months, while the median age for first signs and symptoms was 2 years and 5 months (N = 72). Using the comparative genomic hybridization technique, we have reported a high frequency of 9q34 amplification in adenomas and carcinomas. This finding has been confirmed more recently by investigators in England. The lower socioeconomic status, the distinctive ethnic groups and all the regional differences in Southern Brazil in relation to patients in England indicate that these differences are not important to determine 9q34 amplification. Candidate amplified genes mapped to this locus are currently being investigated and Southern blot results obtained so far have discarded amplification of the abl oncogene. Amplification of 9q34 has not been found to be related to tumor size, staging, or malignant histopathological features, nor does it seem to be responsible for the higher incidence of ACT observed in Southern Brazil, but could be related to an ACT from embryonic origin.

HHV-8 infection in patients with AIDS-related Kaposi's sarcoma in Brazil

The aims of the present study were to determine the prevalence of human herpesvirus type 8 (HHV-8) in HIV-positive Brazilian patients with (HIV+/KS+) and without Kaposi's sarcoma (HIV+/KS-) using PCR and immunofluorescence assays, to assess its association with KS disease, to evaluate the performance of these tests in detecting HHV-8 infection, and to investigate the association between anti-HHV-8 antibody titers, CD4 counts and staging of KS disease. Blood samples from 66 patients, 39 HIV+/KS+ and 27 HIV+/KS-, were analyzed for HHV-8 viremia in peripheral blood mononuclear cells by PCR and HHV-8 antigenemia for latent and lytic infection by immunofluorescence assay. Positive samples for latent nuclear HHV-8 antigen (LNA) antibodies were titrated out from 1/100 to 1/409,600 dilution. Clinical information was collected from medical records and risk behavior was assessed through an interview. HHV-8 DNA sequences were detected by PCR in 74.3% of KS+ patients and in 3.7% of KS- patients. Serological assays were similar in detecting anti-LNA antibodies and anti-lytic antigens in sera from KS+ patients (79.5%) and KS- patients (18.5%). HHV-8 was associated with KS whatever the method used, i.e., PCR (odds ratio (OR) = 7.4, 95% confidence interval (CI) = 2.16-25.61) or anti-LNA and anti-lytic antibodies (OR = 17.0, 95%CI = 4.91-59.14). Among KS+ patients, HHV-8 titration levels correlated positively with CD4 counts (rho 0.48, P = 0.02), but not with KS staging. HHV-8 is involved in the development of KS in different geographic areas worldwide, as it is in Brazil, where HHV-8 is more frequent among HIV+ patients. KS severity was associated with immunodeficiency, but no correlation was found between HHV-8 antibody titers and KS staging.

Expression of c-erbB-2, p53 and c-myc proteins in male breast carcinoma: Comparison with traditional prognostic factors and survival

There are few data evaluating biological markers for men with breast cancer. The purpose of the present study was to analyze the expression of the oncogenes c-erbB-2 and c-myc and of the suppressor gene p53 by immunohistochemical techniques in archival paraffin-embedded tissue blocks of 48 male breast cancer patients, treated at the A.C. Camargo Cancer Hospital, São Paulo, SP, Brazil. The results were compared with clinicopathological prognostic features. Immunopositivity of c-erbB-2, p53 and c-myc was detected in 62.5, 16.7 and 20.8% of the cases analyzed, respectively. Estrogen and progesterone receptors were positive in 75 and 69% of the cases, respectively. Increasing staging was statistically associated with c-erbB-2 (P = 0.04) and weakly related to p53 positivity (P = 0.06). No significant correlation between specific survival rate (determined by the log rank test) and the molecular markers analyzed was found, whereas the number of compromised lymph nodes and advanced TNM (tumor, node, metastasis) staging were associated with diminished survival.

Vertical growth phase and positive sentinel node in thin melanoma

Sentinel node (SN) status is the most important prognostic factor for localized melanoma. Usually, patients with Breslow thickness of less than 1.0 mm are not included in SN protocols. However, the literature presents a rate ranging from 3 to 7% of nodal recurrence in thin melanoma. Ulceration, regression and high mitotic rate have been considered to be indications for an SN biopsy. The metastatic potential of the vertical growth phase is uncertain. To correlate pathological features in thin melanoma with SN metastasis, we reviewed 358 patients submitted to SN biopsy. Seventy-seven patients with lesions of 1 mm or smaller were included in the study group. Histological evaluation of the primary tumor included thickness, Clark level, mitotic rate, ulceration, regression, and growth phase. Lymphoscintigraphy was performed on all patients. Lymphatic mapping and gamma probe detection were both used for SN biopsy. Histological examination of SN consisted of hematoxylin-eosin and immunohistochemical staining. Median follow-up was 37 months. Six patients had micrometastases. Statistical analysis by the Fisher test showed that ulceration (P = 0.019), high mitotic rate (P = 0.008) and vertical growth phase (P = 0.002) were positively correlated with micrometastases. If other studies confirm these results, more melanoma patients must be submitted to SN biopsy.