Trimodal therapy for invasive bladder cancer: is it really equal to radical cystectomy?

PURPOSE OF REVIEW: Trimodal therapy (TMT) is considered the most effective bladder-sparing approach for muscle-invasive urothelial carcinoma of the bladder (MIBC) and an alternative to radical cystectomy. The purpose of this article was to review and summarize the current knowledge on the equivalence of TMT and radical cystectomy based on the recent literature. RECENT FINDINGS: TMT consists of a maximal transuretral resection of the bladder, followed by a concurrent radiotherapy and chemotherapy, limiting salvage radical cystectomy to nonresponder tumors or muscle-invasive recurrence. In large population studies, less than 6% of the patients with nonmetastatic MIBC receive a chemoradiation therapy and this rate is stable. A growing body of evidence exists that TMT provides good oncologic outcomes with low morbidity when compared with radical cystectomy. TMT requires, however, a close follow-up because of the high risk of local recurrence and salvage radical cystectomy in up to 30% of the patients. Salvage radical cystectomy can be performed with adequate results but does not offer the same opportunity of reconstruction and functional outcomes than primary radical cystectomy. SUMMARY: Although radical cystectomy is still the treatment of reference for most of the patients with localized MIBC, TMT represents a reasonable alternative in highly selected patients. Any firm conclusion on the equivalence or superiority of one treatment to the other is still limited by the lack of randomized controlled trials and the heterogeneity of the available literature. Future studies and multidisciplinary approach are mandatory to optimize the patient selection and regimen of TMT.

Le Bloc républicain du Gâtinais : organe des partis radical-socialiste et socialiste ["puis" organe des radicaux, radicaux-socialistes et socialistes], paraissant le samedi

1906/04/07 (A1,N4).

Analysis of passion fruit rinds (Passiflora edulis): isoorientin quantification by HPTLC and evaluation of antioxidant (radical scavenging) capacity

The content of isoorientin in passion fruit rinds (Passiflora edulis fo. flavicarpa O. Degener) was determined by HPTLC (high performance thin layer chromatography) with densitometric analysis. The results revealed a higher amount of isoorientin in healthy rinds of P. edulis (92.275 ± 0.610 mg L-1) than in rinds with typical symptoms of PWV (Passion fruit Woodiness Virus) infection (28.931 ± 0.346 mg L-1). The HPTLC data, allied to assays of radical scavenging activity, suggest the potential of P. edulis rinds as a natural source of flavonoids or as a possible functional food.

In vitro radical-scavenging activity, toxicity against A. salina, and nmr profiles of extracts of lichens collected from Brazil and Antarctica

Extracts of six lichen species collected from Brazil and Antarctica were investigated for their potential toxicity and radical-scavenging properties. The composition of the extracts was investigated using TLC and NMR, leading to identification of atranorin (1), along with salazinic (2), barbatic (3), α-alectoronic (4), α-collatolic (5), cryptochlorophaeic (6), caperatic (7), lobaric (8), and protolichesterinic (9) acids. All acetone extracts were evaluated for their 2,2'-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging ability and subjected to Artemia salina bioassay. The free-radical-scavenging activities of each extract (100 µg) ranged from 8.9 ± 0.1% to 38.7 ± 2.5% and the EC50 values ranged from 0.24 ± 2.10 to 3.54 ± 0.28 mg mL-1, while the toxicity of the extracts against A. salina were low (151.0 to >600 µg mL-1).

HPLC-DAD based method for the quantification of flavonoids in the hydroethanolic extract of Tonina fluviatilis Aubl. (Eriocaulaceae) and their radical scavenging activity

This article describes the isolation and identification of flavonoids in the hydroethanolic extract of the aerial parts from Tonina fluviatilis and evaluation of their antiradical activity. A method based on HPLC-DAD was developed and validated for detecting and quantifying flavonoids in hydroethanolic extracts. The flavonoids identified and quantified in the extract were 6,7-dimethoxyquercetin-3-O-β-D-glucopyranoside (1), 6-hydroxy-7-methoxyquercetin-3-O-β-D-glucopyranoside (2), and 6-methoxyquercetin-3-O-β-D-glucopyranoside (3). The developed method presented good validation parameters, showing that the results obtained are consistent and can be used in ensuring the quantification of these constituents in the extracts. Compounds 2 and 3 showed strong antiradical activity when compared with the positive controls (quercetin and gallic acid).

CHEMICAL CONSTITUENTS, ANTI-INFLAMMATORY, AND FREE-RADICAL SCAVENGING ACTIVITIES OF Guettarda viburnoides CHAM. & SCHLTDL. (RUBIACEAE)

Chemical investigation of Guettarda viburnoides (leaves) led to the isolation of ursolic acid, uncaric acid, secoxyloganin, and grandifloroside, along with a mixture of quercetin-3-O-β-D-galactopyranoside and quercetin-3-O-β-D-glucopyranoside, and of β-sitosterol and stigmasterol. The structures of the isolated compounds were elucidated on the basis of their NMR data. The crude extract, ethyl acetate fraction, aqueous-methanol fraction, and grandifloroside showed significant DPPH free-radical scavenging activities with IC50 ranging from 18.92 to 26.47 µg mL-1. The topical administration of the crude extract and fractions markedly reduced the croton oil-induced mice ear edema in 67.0%-99.0%. Inhibition of tissue MPO activity was also observed, which demonstrated an anti-inflammatory effect of the G. viburnoides species.

AVALIAÇÃO DO RADICAL N,N-DIETIL-1,4-FENILENODIAMINO (DEPD•+) COMO SONDA ESPECTROFOTOMÉTRICA PARA DETERMINAÇÃO DA CAPACIDADE ANTIOXIDANTE EM BEBIDAS

AbstractMany well-established methods for determining the antioxidant capacities in several samples have been described in literature. However, DPPH (2,2-diphenyl-1-picrylhydrazyl) and ABTS (2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid)) are the main two methods that utilize radicals as spectrophotometric probes for analysis. Nevertheless, these methods have certain limitations because of their slower kinetics, solvent polarity effects, the hydrophilicity and lipophilicity of the compounds, chemical costs, etc. In this study, a spectrophotometric method for determining the antioxidant capacity in beverages was developed based on an exploration of the cation radical derived from DEPD. This method was based on the oxidation of aromatic amines with Fe(III) ions at pH 4.0, which leads to their corresponding purple cation radicals (DEPD•+) with λmax values at 500 and 540 nm. The addition of an antioxidant after the formation of the radical leads to a reduction in color intensity that is proportional to the antioxidant concentration in the medium. Results obtained using this method were compared with the Folin-Ciocalteau, ABTS and DPPH methods in terms of applications in wines, teas, and infusions samples. Linear correlation analysis at a 95% confidence level was employed to compare the results, which were in good agreement with a correlation coefficient of r > 0.9000. Thus, the developed method was simple, accurate, and consistent with other assays for the determination of the total amount of phenolic compounds and antioxidant capacity.

Interposição jejunal após gastrectomia total radical por adenocarcinoma gástrico

Realizamos um estudo retrospectivo do tratamento cirúrgico do adenocarcinoma gástrico por uma gastrectomia total radical, com reconstrução do trânsito esofagoduodenal pela interposição de uma alça jejunal pediculada. Revisão de trabalhos nacionais e estrangeiros relacionados ao tratamento do adenocarcinoma gástrico pela gastrectomia total radical. De acordo com a operabilidade relacionada ao paciente e à ressecabilidade, à lesão primária e sua evolução, 126 pacientes foram submetidos à interposição de um segmento de alça jejunal após gastrectomia total radical. Ressecção oncológica total do estômago e sistematizada reconstrução técnica do reservatório gástrico e do trânsito esofagoduodenal. Nossos casos evoluíram de maneira satisfatória, não fugindo daqueles estudados na literatura. Ênfase especial foi dada ao procedimento técnico, mais anatômico e muito mais funcional, restituindo ao operado um neoestômago e um trânsito esôfago-intestinal através do duodeno. A interposição de uma alça jejunal pediculada entre o esôfago terminal e a segunda porção do duodeno age como neo-reservatório gástrico. Evita o refluxo esofágico e direciona o bolo alimentar para o delgado através do duodeno, trânsito anatômico e funcional capaz de proporcionar melhor qualidade de vida ao gastrectomizado total.

Influência da linfadenectomia radical (D2) na morbidade e mortalidade da ressecção curativa do carcinoma gástrico

A despeito da controvérsia existente na literatura com relação aos benefícios da linfadenectomia na sobrevida dos doentes submetidos a ressecções curativas para tratamento do adenocarcinoma gástrico, é inegável que a linfadenectomia ampliada (nível II na classificação japonesa) contribui para o melhor estadiamento e prognóstico destes pacientes. Este procedimento permite-nos melhor identificar aqueles pacientes que têm pior prognóstico e oferecer-lhes novas formas de terapia adjuvante. Como o principal argumento para a não realização de cirurgias mais alargadas é que estas são acompanhadas de maior morbidade e mortalidade, os autores estudaram prospectivamente parâmetros relacionados a esses índices nas gastrectomias com linfadenectomia nível 11 (D2) que tiveram intenção curativa. Para tanto, estudaram-se a taxa de mortalidade, o tempo operatório, as unidades de glóbulos transfundidas, as complicações e o tempo de internação pós-operatória. Entre dezembro de 1992 e fevereiro de 1997 foram internados 86 pacientes com diagnóstico de adenocarcinoma gástrico, dos quais, em 27, atendidos por uma mesma equipe interessada no tratamento destes tumores, houve ressecção cirúrgica com intenção curativa e o tratamento consistiu de gastrectomia acompanhada de linfadenectomia D2. A gastrectomia subtotal foi realizada em 17 doentes, a total em três e a total ampliada em sete. Nove doentes tinham tumores superficiais. Não houve mortalidade entre os pacientes submetidos a ressecções D2; o tempo médio operatório foi de 208,7 minutos; receberam em média 0,2 unidades de glóbulos e a incidência de complicações foi de 33,3%. A permanência hospitalar pós-operatória média foi de 8,6 dias. Foram estudados 854 linfonodos, dos quais 22,1% eram positivos para tumor metastático. Os autores concluem que a dissecção D2 pode ser feita de forma segura e não deve ser evitada por causa do risco de complicações. Permite estadiamento anatomopatológico mais preciso e melhor avaliação do prognóstico destes pacientes.