Linfedema em Pacientes Submetidas à Mastectomia Radical Modificada

Objetivo: avaliar a taxa de linfedema em pacientes tratadas cirurgicamente para câncer de mama e sua relação com o tipo de cirurgia, idade e peso das pacientes. Métodos: foram estudadas 109 pacientes portadoras de câncer de mama, submetidas à mastectomia radical modificada com conservação do músculo peitoral maior ou de ambos os peitorais. Considerou-se como linfedema quando houve diferença maior que 2,0 cm entre as circunferências dos membros superiores, mensurados acima e abaixo do olécrano. Resultados: observou-se uma taxa total de 14% de linfedema (15 casos). Entre as pacientes em que foram conservados ambos os músculos peitorais, a taxa foi de (9%), ao passo que quando se empregou a conservação apenas do grande peitoral, a taxa foi de 15% (p<0,4). Notou-se uma relação significativa entre a freqüência de linfedema e o peso e a idade das pacientes. O linfedema foi observado em apenas uma das 34 pacientes com menos de 46 anos e nenhuma das 19 pacientes com até 50 kg de peso apresentou linfedema. Conclusão: Na presente série, o linfedema de membro superior esteve associado a pacientes mais idosas e de maior peso.

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.

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.

Measurement of antioxidant activity with trifluoperazine dihydrochloride radical cation

A novel, rapid and cost-effective trifluoperazine dihydrochloride (TFPH) decolorization assay is described for the screening of antioxidant activity. A chromogenic reaction between TFPH and potassium persulfate at low pH produces an orange-red radical cation with maximum absorption at 502 nm in its first-order derivative spectrum. TFPH was dissolved in distilled water to give a 100 mM solution. The TFPH radical cation solution was made by reacting 0.5 mL of the solution with K2S2O8 (final concentration: 0.1 mM) and diluting to 100 mL with 4 M H2SO4 solution. A linear inhibition of color production was observed with linearly increasing amounts of antioxidants, with correlation coefficients (R²) ranging from 0.999 to 0.983. The antioxidant capacity of standard solutions of an antioxidant was evaluated by comparing with the inhibition curve using Trolox as the standard. Comparison of antioxidant capacity determined with this newly developed TFPH assay and with the well-known 2,2'-azinobis-[3-ethylbenzthiazoline-6-sulfonic acid] (ABTS)-persulfate decolorization assay indicated the efficacy and sensitivity of the procedure. The proposed assay is less expensive (costs about US$4 per 100 assays) and requires only 20 min for preparation of radical cation solution in comparison with ABTS assay, in which almost 12-16 h are required for preparation of a stable ABTS radical cation solution. The present assay has the advantage over ABTS assay that it can be used to measure the antioxidant activity of the samples, which are naturally found at a pH as low as 1, because the radical cation itself has been stabilized at low pH.

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.

Não há dente de coelho no problema da tradução radical

O trabalho consiste em uma tentativa de refutação do princípio quineano da indeterminação da tradução radical. A estrutura do argumento é a seguinte. A demonstração do princípio no texto de Quine assenta-se sobre certa concepção do processo de tradução radical. Esta concepção só se sustenta se são adotadas certas pressuposições a respeito da natureza da linguagem e dos falantes. Entretanto, se estas pressuposições são adotadas, não há razão para não se aceitarem também outras pressuposições - as quais invalidam a demonstração de Quine.

O conceito de mal radical

A noção de mal radical aparece em Kant no contexto da discussão da religião nos limites da simples razão e busca dar conta da complexa relação entre o respeito pela lei moral e o amor-próprio na definição do móbil para a ação. Na busca por identificar o fundamento da propensão para o mal no homem, Kant se vê diante da dificuldade de ter de articular natureza e liberdade, e ainda que a noção de mal radical possa conservar algumas ambigüidades, permite conceber uma noção de responsabilidade compatível com uma inata propensão para o mal. Neste texto busco explicitar alguns passos fundamentais na construção do conceito por Kant.

La vida humana como principio interpretativo radical en la filosofía de Ortega y Gasset

En este artículo presentamos el concepto de vida humana como texto eterno en el pensamiento de Ortega y sus consecuencias para el problema de la interpretación. La filosofía de la razón vital de Ortega se fundamenta en el concepto de vida humana como realidad radical y principio interpretativo universal, y por esta razón se presenta desde el principio como una filosofía hermenéutica de la vida y no como una reducción hacia la conciencia trascendental. Esta hermenéutica se practica especialmente en el ámbito del arte. Pero para Ortega todo texto es hermenéutico y necesita por tanto la interpretación, porque ningún texto posee en sí mismo su verdad.