Sobrevivência tardia (cinco anos) após tratamento cirúrgico radical e quimioterápico adjuvante (FAM) em câncer gástrico avançado: estudo controlado

Várias são as drogas e associações propostas tanto para a quimioterapia adjuvante como complementar visando melhorar os resultados do tratamento do câncer gástrico. Com o objetivo de se analisar o impacto sobre o estado nutricional e o índice de sobrevivência no tratamento de 53 doentes com câncer gástrico do estádio III da classificação TNM, comparou-se um grupo controle composto de 28 doentes submetidos apenas a ressecção radical com outro grupo tratado com a mesma conduta operatória seguida de poliquimioterapia adjuvante pelo regime FAM (5-fluorouracil, adriamicina e mitomicina C) e composto de 25 doentes. Nestes últimos averiguou-se também a toxicidade das drogas antineoplásicas quanto à função hepática, renal, cardiológica, neurológica, hematológica, gastrointestinal e dermatológica. Por meio de análise estatística afastou-se desigualdade entre os dois grupos de estudo quanto ao sexo, raça, tipo tumoral macroscópico da classificação de Borrmann, localização da neoplasia no estômago, extensão da ressecção gástrica e resposta às provas cutâneas de sensibilidade retardada na admissão. O tratamento quimioterápico foi iniciado em média 2,3 meses após o tratamento cirúrgico. Os doentes foram acompanhados clínica e laboratorialmente pelo período de 5 anos tendo se chegado às seguintes conclusões: 1) Foram semelhantes em ambos os grupos de estudo a evolução nutricional e a incidência de manifestações gastrintestinais; 2) não ocorreu toxicidade cardíaca, renal, neurológica ou hepática e tampouco óbito em decorrência do método quimioterápico em si; 3) alterações dermatológicas e mielotoxicidade ocorreram exclusivamente nos doentes que se submeteram à poliquimioterapia; 4) não houve diferença significante entre o índice e a sede da recidiva tumoral, o tempo livre de doença e os índices de sobrevivência dos dois grupos de estudo após cinco anos de seguimento portanto, a quimioterapia pelo esquema FAM não incrementa o referido índice.Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate

Digestive adaptation: A new surgical proposal to treat obesity based on physiology and evolution

Objective: To report on a new surgical technique to treat obesity -Digestive Adaptation - and to present its preliminary results.Method: The technique includes a vertical (sleeve) gastrectomy,omentectomy and enterectomy maintaining the initial 150-cmportionof the jejunum and the final 150-cm-portion of the ileum.The three first obese patients operated on are described. Results:With a minimum follow-up of 6 months, all patients refer earlysatiety, are free of symptoms and have a BMI <31 Kg/m2.Conclusions: This procedure does not use prostheses and doesnot cause exclusion of gastrointestinal segments. It does notcreate subocclusions neither malabsorption nor blind endoscopicareas and above all, it causes no harm to important digestivefunctions. Conversely, it aims at moderate restriction with earlysatiety by distension, and at interfering in the neuroendocrineprofile, resulting in slow gastric emptying, early and prolongedsatiety, as well as positive changes in the metabolic profile. Basedon recent physiological data, the procedure aims at decreasingthe production of ghrelin, plasminogen activator inhibitor-1 (PAI-1)and resistin, and at raising the levels of glucagon-like peptide-1(GLP-1). The patients operated on do not need nutritional supportor to take drugs because of the procedure, which is easy and safeto perform

Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report

The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.Relata-se um caso de paciente com adenocarcinoma gástrico com indicação de gastrectomia. O ato operatório transcorreu sem anormalidades. Foi realizada gastrectomia subtotal paliativa, pois encontrou-se linfonodos para-aórticos comprometidos pela neoplasia, confirmado por exame anátomo-patológico de congelação realizado no decorrer da intervenção. Ao fim da confecção da gastroêntero-anastomose o paciente passou a apresentar bradicardia intensa: 38 batimentos por minuto (bpm), hipotensão arterial, alterações do traçado do eletrocardiograma (Supra-desnivelamento do segmento ST) e parada cardíaca. Realizadas as manobras de ressucitação com sucesso temporário, já que a seguir o paciente apresentou novo colapso circulatório, sendo novamente recuperado, finalmente a 3a parada cardíaca foi irreversível e constatou-se o óbito intra-operatório

Tratamento cirúrgico da doença pilonidal: meta-análise dos principais procedimentos adotados mundialmente

OBJETIVO: Analisar e comparar os diversos procedimentos cirúrgicos descritos para o tratamento da doença pilonidal. MÉTODO: Foram selecionados 34 trabalhos publicados em revistas indexadas, totalizando 8698 doentes operados. Realizou-se meta-análise para comparação das sete principais técnicas cirúrgicas descritas na literatura, quanto aos resultados em relação à recidiva e ao tempo de cicatrização no pós-operatório. RESULTADOS: Do total de doentes estudados, houve recidiva em 230 doentes (2,6%). O tempo de cicatrização no pós-operatório foi significantemente maior no grupo de excisão sem sutura. As recidivas foram estatisticamente semelhantes nos métodos: excisão sem sutura, marsupialização, incisão e curetagem, excisão e retalho e técnica de Karidakys. Os métodos que apresentaram maior índice de recidiva (estatisticamente significante - p<0,001) foram: excisão e sutura primária e o método de Bascom. CONCLUSÕES: Conclui-se, por esse estudo, que os resultados em relação à recidiva são estatisticamente semelhantes em todos os métodos, com exceção da excisão e sutura primária e da técnica de Bascom, que apresentaram recidivas mais freqüentes. O tempo de cicatrização foi maior nos indivíduos operados pela técnica de excisão sem sutura primária

Stable isotope constraints on Holocene carbon cycle changes from an Antarctic ice core

Reconstructions of atmospheric CO2 concentrations based on Antarctic ice cores1,2 reveal significant changes during the Holocene epoch, but the processes responsible for these changes in CO2 concentrations have not been unambiguously identified. Distinct characteristics in the carbon isotope signatures of the major carbon reservoirs (ocean, biosphere, sediments and atmosphere) constrain variations in the CO2 fluxes between those reservoirs. Here we present a highly resolved atmospheric δ13C record for the past 11,000 years from measurements on atmospheric CO2 trapped in an Antarctic ice core. From mass-balance inverse model calculations3,4 performed with a simplified carbon cycle model, we show that the decrease in atmospheric CO2 of about 5 parts per million by volume (p.p.m.v.). The increase in δ13C of about 0.25‰ during the early Holocene is most probably the result of a combination of carbon uptake of about 290 gigatonnes of carbon by the land biosphere and carbon release from the ocean in response to carbonate compensation of the terrestrial uptake during the termination of the last ice age. The 20 p.p.m.v. increase of atmospheric CO2 and the small decrease in δ13C of about 0.05‰ during the later Holocene can mostly be explained by contributions from carbonate compensation of earlier land-biosphere uptake and coral reef formation, with only a minor contribution from a small decrease of the land-biosphere carbon inventory

Carbon dioxide and climate impulse response functions for the computation of greenhouse gas metrics: a multi-model analysis

The responses of carbon dioxide (CO2) and other climate variables to an emissionpulse of CO2into the atmosphere are often used to compute the Global WarmingPotential (GWP) and Global Temperature change Potential (GTP), to characterizethe response time scales of Earth System models, and to build reduced-form mod-5els. In this carbon cycle-climate model intercomparison project, which spans the fullmodel hierarchy, we quantify responses to emission pulses of different magnitudes in-jected under different conditions. The CO2response shows the known rapid declinein the first few decades followed by a millennium-scale tail. For a 100 GtC emissionpulse, 24±10 % is still found in the atmosphere after 1000 yr; the ocean has absorbed1060±18 % and the land the remainder. The response in global mean surface air tem-perature is an increase by 0.19±0.10◦C within the first twenty years; thereafter anduntil year 1000, temperature decreases only slightly, whereas ocean heat content andsea level continue to rise. Our best estimate for the Absolute Global Warming Po-tential, given by the time-integrated response in CO2at year 100 times its radiative15efficiency, is 92.7×10−15yr Wm−2per kg CO2. This value very likely (5 to 95% confi-dence) lies within the range of (70 to 115)×10−15yr Wm−2per kg CO2. Estimates fortime-integrated response in CO2published in the IPCC First, Second, and Fourth As-sessment and our multi-model best estimate all agree within 15%. The integrated CO2response is lower for pre-industrial conditions, compared to present day, and lower for20smaller pulses than larger pulses. In contrast, the response in temperature, sea leveland ocean heat content is less sensitive to these choices. Although, choices in pulsesize, background concentration, and model lead to uncertainties, the most importantand subjective choice to determine AGWP of CO2and GWP is the time horizon.ISSN:1680-7375ISSN:1680-736