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Coelho Dos Reis JGA, Ferreira GM, Lourenço AA, Ribeiro ÁL, da Mata CPDSM, de Melo Oliveira P, Marques DPDA, Ferreira LL, Clarindo FA, da Silva MF, Filho HPP, Oliveira NRR, Sodré MMD, Gadelha SR, Albuquerque GR, Maciel BM, Mariano APM, Silva MDM, Fontana R, Marin LJ, Carlos RSA, Lopes ATS, Ferreira FB, Dos Santos UR, Santana ÍTSD, Fehlberg HF, Rezende RP, Dias JCT, Gross E, Goulart GAC, Santiago MG, de Lemos APML, da Conceição AO, Romano CC, de Carvalho LD, Martins Filho OA, Quadros CA, Morris DL, Valle SJ. Ex-vivo mucolytic and anti-inflammatory activity of BromAc in tracheal aspirates from COVID-19. Biomed Pharmacother 2022; 148:112753. [PMID: 35272139 PMCID: PMC8872962 DOI: 10.1016/j.biopha.2022.112753] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Abstract
COVID-19 is a lethal disease caused by the pandemic SARS-CoV-2, which continues to be a public health threat. COVID-19 is principally a respiratory disease and is often associated with sputum retention and cytokine storm, for which there are limited therapeutic options. In this regard, we evaluated the use of BromAc®, a combination of Bromelain and Acetylcysteine (NAC). Both drugs present mucolytic effect and have been studied to treat COVID-19. Therefore, we sought to examine the mucolytic and anti-inflammatory effect of BromAc® in tracheal aspirate samples from critically ill COVID-19 patients requiring mechanical ventilation. Method Tracheal aspirate samples from COVID-19 patients were collected following next of kin consent and mucolysis, rheometry and cytokine analysis using Luminex kit was performed. Results BromAc® displayed a robust mucolytic effect in a dose dependent manner on COVID-19 sputum ex vivo. BromAc® showed anti-inflammatory activity, reducing the action of cytokine storm, chemokines including MIP-1alpha, CXCL8, MIP-1b, MCP-1 and IP-10, and regulatory cytokines IL-5, IL-10, IL-13 IL-1Ra and total reduction for IL-9 compared to NAC alone and control. BromAc® acted on IL-6, demonstrating a reduction in G-CSF and VEGF-D at concentrations of 125 and 250 µg. Conclusion These results indicate robust mucolytic and anti-inflammatory effect of BromAc® ex vivo in tracheal aspirates from critically ill COVID-19 patients, indicating its potential to be further assessed as pharmacological treatment for COVID-19.
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Affiliation(s)
- Jordana Grazziela A Coelho Dos Reis
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Geovane Marques Ferreira
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alice Aparecida Lourenço
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ágata Lopes Ribeiro
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Patrícia de Melo Oliveira
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Daisymara Priscila de Almeida Marques
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Linziane Lopes Ferreira
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Felipe Alves Clarindo
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Murillo Ferreira da Silva
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | | | - Maisah Meyhr D'Carmo Sodré
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Sandra Rocha Gadelha
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - George Rego Albuquerque
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil; Department of Agricultural and Environmental Sciences (DCAA), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Bianca Mendes Maciel
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Ana Paula Melo Mariano
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Mylene de Melo Silva
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Renato Fontana
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Lauro Juliano Marin
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil; Department of Health Sciences (DCS), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | - Amanda Teixeira Sampaio Lopes
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Fabrício Barbosa Ferreira
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | | | - Hllytchaikra Ferraz Fehlberg
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | - João Carlos T Dias
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil
| | - Eduardo Gross
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil
| | - Gisele Assis Castro Goulart
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marie Gabriele Santiago
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Aline O da Conceição
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil
| | | | | | - Olindo Assis Martins Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | | | - David L Morris
- Mucpharm Pty Ltd, Sydney, NSW, Australia; University of New South Wales, St George & Sutherland Hospital Clinical School, Sydney, NSW, Australia; Department of Surgery, St George Hospital, Sydney, NSW, Australia.
| | - Sarah J Valle
- Mucpharm Pty Ltd, Sydney, NSW, Australia; University of New South Wales, St George & Sutherland Hospital Clinical School, Sydney, NSW, Australia.
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Oliveira AF, Quadros CA, de Castro Ribeiro HS, Wainstein AJA, de Queiroz Sarmento BJ, Lyra J, Baiocchi Neto G, Ribeiro R, Pinheiro RN, da Silva Barreto EJS, Park J, McKay A, Gupta A, Savant D, Nissan A, Zippel D, Leon A, Bargallo-Rocha JE, Martinez Said H, Kitagawa Y, Yoshida K, Lee WY, Park DJ, Zaghloul A, Gawad WA, Chen G, Majid HJ, Cheema MA, Gronchi A, Kovacs T, D'Ugo D, Bartlett DL, Howe JR, Are C. Global Forum of Cancer Surgeons: Support for the Brazilian Society of Surgical Oncology Journey towards Implementation of Cytoreductive Surgery/Hyperthermic Intraperitoneal Chemotherapy in Brazil. Ann Surg Oncol 2021; 28:1892-1895. [PMID: 33462717 DOI: 10.1245/s10434-020-09527-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Alexandre Ferreira Oliveira
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil.,Latin American Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Claudio Almeida Quadros
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil.,Latin American Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Héber Salvador de Castro Ribeiro
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil.,Latin American Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | - Jorge Lyra
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | - Reitan Ribeiro
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | - Jason Park
- Canadian Society of Surgical Oncology, Toronto, ON, Canada
| | - Andrew McKay
- Canadian Society of Surgical Oncology, Toronto, ON, Canada
| | - Arnab Gupta
- Indian Association of Surgical Oncology, Miraj, Maharashtra, India
| | | | - Aviram Nissan
- Israeli Society of Surgical Oncology, Ramat Gan, Israel
| | | | | | - Juan Enrique Bargallo-Rocha
- Latin American Society of Surgical Oncology, Rio de Janeiro, Brazil.,Sociedad Mexicana de Oncologia, Mexico City, Mexico
| | - Hector Martinez Said
- Latin American Society of Surgical Oncology, Rio de Janeiro, Brazil.,Sociedad Mexicana de Oncologia, Mexico City, Mexico
| | - Yuko Kitagawa
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Woo Yong Lee
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, Korea
| | - Do Joong Park
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, Korea
| | | | - Wael A Gawad
- Egyptian Society of Surgical Oncology, Cairo, Egypt
| | - Gong Chen
- Chinese Society of Surgical Oncology, Beijing, China
| | | | | | | | - Tibor Kovacs
- European Society of Surgical Oncology, Brussels, Belgium
| | - Domenico D'Ugo
- Italian Society of Surgical Oncology, Napoli, Italy.,European Society of Surgical Oncology, Brussels, Belgium
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3
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Quadros CA, Leal MCBDM, Baptista-Sobrinho CDA, Nonaka CKV, Souza BSDF, Milan-Mattos JC, Catai AM, Pires Di Lorenzo VA, Ferreira AG. Preclinical validation of occupational and environmental safety of an isolation system for noninvasive ventilation in COVID-19 and other aerosol-transmitted infections. Expert Rev Med Devices 2020; 17:1211-1220. [PMID: 33103939 DOI: 10.1080/17434440.2020.1842190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: The current SARS-CoV-2 pandemic has provoked the collapse of some health systems due to insufficient intensive care unit capacity. The use of continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) therapies has been limited in consideration of the risk of occupational infection in health-care professionals. Aims: In preclinical experimental simulations, evaluate occupational and environmental safety of the newly developed isolation system for aerosol-transmitted infections (ISATI). Method: Simulations were conducted to test ISATI's capability to isolate aerosolized molecular (caffeine), and biological (SARS-CoV-2 synthetic RNA) markers. Caffeine deposition was analyzed on nitrocellulose sensor discs by proton nuclear magnetic resonance spectroscopy. Synthetic SARS-CoV-2 detection was performed by reverse transcription-polymerase chain reaction. Results: ISATI demonstrated efficacy in isolating molecular and biological markers within the enclosed environment in simulated conditions of CPAP, HFNO and mechanical ventilation therapy. Neither the molecular marker nor substantial amounts of synthetic SARS-CoV-2 RNA were detected in the surrounding environment, outside ISATI, indicating appropriate occupational safety for health-care professionals. Conclusion: Aerosolized markers were successfully contained within ISATI in all experimental simulations, offering occupational and environmental protection against the dissemination of aerosolized microparticles under CPAP or HFNO therapy conditions, which are indicated for patients with acute respiratory infections.
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Affiliation(s)
- Claudio Almeida Quadros
- Department of Life Sciences, Bahia State University, Medical School , Salvador, Bahia, Brazil
| | | | | | - Carolina Kymie Vasques Nonaka
- Center for Biotechnology and Cell Therapy, São Rafael Hospital , Salvador, Bahia, Brazil.,D'Or Institute for Research and Education , Rio De Janeiro, Brazil
| | - Bruno Solano De Freitas Souza
- Center for Biotechnology and Cell Therapy, São Rafael Hospital , Salvador, Bahia, Brazil.,D'Or Institute for Research and Education , Rio De Janeiro, Brazil.,Gonçalo Moniz Institute, FIOCRUZ , Salvador, Bahia, Brazil
| | | | - Aparecida Maria Catai
- Department of Physiotherapy, São Carlos Federal University , São Carlos, São Paulo, Brazil
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4
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Spencer RMSSB, Castro Ribeiro HS, Araujo RLC, Costa WL, Oliveira AF, Cordeiro EZ, Huguenin JFL, Anghinoni M, Silva EJS, Laporte GA, Gadelha MIP, Melo RL, Almeida Quadros C, Lopes A. Challenges in surgical oncology training in Brazil: From history to a board‐certified specialization. J Surg Oncol 2020; 121:707-717. [DOI: 10.1002/jso.25850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Wilson Luiz Costa
- Department of Surgical OncologyAC Camargo Cancer Center Hospital São Paulo Brazil
| | | | | | | | - Marciano Anghinoni
- Directory MembersBrazilian Society of Surgical Oncology (BSSO) Board São Paulo Brazil
| | | | | | | | - Rosana Leite Melo
- President of Medical Residency National CommiteeMedical Residency National Committee São Paulo Brazil
| | | | - Ademar Lopes
- Department of Surgical OncologyAC Camargo Cancer Center Hospital São Paulo Brazil
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5
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Are C, McMasters KM, Giuliano A, Yanala U, Balch C, Anderson BO, Berman R, Audisio R, Kovacs T, Savant D, Toprani R, Amira G, Sallam I, Baek JH, Baek MJ, Park DJ, Beulo GQ, Rocha EB, Said HM, Cheema M, AliKhan A, Mack L, Chen G, Quadros CA, Reis T, de Castro Ribeiro HS, Zippel D, Ramirez AL, Seto Y, Yoshida K, Mori M. Global Forum of Cancer Surgeons: Perspectives on Barriers to Surgical Care for Cancer Patients and Potential Solutions. Ann Surg Oncol 2019; 26:1577-1582. [PMID: 30911947 DOI: 10.1245/s10434-019-07301-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Chandrakanth Are
- Society of Surgical Oncology, Rosemont, IL, USA. .,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | | | | | - Ujwal Yanala
- Society of Surgical Oncology, Rosemont, IL, USA.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | | | | | | | | | - Tibor Kovacs
- European Society of Surgical Oncology, Brussels, Belgium
| | | | | | - Gamal Amira
- Egyptian Society of Surgical Oncology, Cairo, Egypt
| | | | - Jeong Heum Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Moo-Jun Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Do Joong Park
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Gregorio Quintero Beulo
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Enrique Bargallo Rocha
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Hector Martinez Said
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | | | - Abul AliKhan
- Pakistan Society of Surgical Oncology, Lahore, Pakistan
| | - Lloyd Mack
- Canadian Society of Surgical Oncology, Toronto, ON, Canada
| | - Gong Chen
- Chinese Society of Clinical Oncology, Beijing, China
| | - Claudio Almeida Quadros
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Tarcisio Reis
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Heber Salvador de Castro Ribeiro
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | - Yasuyuki Seto
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Masaki Mori
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
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6
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Are C, McMasters KM, Giuliano A, Balch C, Anderson BO, Berman R, Audisio R, Kovacs T, Savant D, Toprani R, Amira G, Sallam I, Baek JH, Baek MJ, Park DJ, Beulo GQ, Bargallo Rocha E, Said HM, Cheema M, AliKhan A, Mack L, Chen G, Quadros CA, Reis T, de Castro Ribeiro HS, Zippel D, Leon Ramirez A. Global Forum of Cancer Surgeons: A Steady Voice for Cancer Surgeons to Improve Surgical Care for Cancer Patients Globally. Ann Surg Oncol 2018; 25:2114-2116. [PMID: 29881928 DOI: 10.1245/s10434-018-6553-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Tibor Kovacs
- European Society of Surgical Oncology, Brussels, Belgium
| | | | | | - Gamal Amira
- Egyptian Society of Surgical Oncology, Cairo, Egypt
| | | | - Jeong Heum Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Moo-Jun Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Do Joong Park
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | | | - Enrique Bargallo Rocha
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Hector Martinez Said
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | | | - Abul AliKhan
- Pakistan Society of Surgical Oncology, Lahore, Pakistan
| | - Lloyd Mack
- Canadian Society of Surgical Oncology, Toronto, ON, Canada
| | - Gong Chen
- Chinese Society of Clinical Oncology, Beijing, China
| | - Claudio Almeida Quadros
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Tarcisio Reis
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Heber Salvador de Castro Ribeiro
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Salvador, Bahia, Brazil
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Quadros CA, Falcão MF, Carvalho ME, Ladeia PA, Lopes A. Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol 2012; 106:653-8. [DOI: 10.1002/jso.23144] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/12/2012] [Indexed: 12/19/2022]
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Quadros CA, Lopes A, Araújo I. Retroperitoneal and lateral pelvic lymphadenectomy mapped by lymphoscintigraphy for rectal adenocarcinoma staging. Jpn J Clin Oncol 2010; 40:746-53. [PMID: 20457722 DOI: 10.1093/jjco/hyq060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The good prognosis of retroperitoneal and lateral pelvic lymphadenectomy has raised the question of whether total mesorectal excision is suitable for adequate staging of rectal adenocarcinoma patients. The aims of this study were to determine the accuracy of dye and probe detection of metastatic retroperitoneal and/or lateral pelvic nodes and to define the upstaging impact of retroperitoneal and lateral pelvic lymphadenectomy in rectal adenocarcinoma patients. METHODS Ninety-seven rectal adenocarcinoma patients were submitted to total mesorectal excision and retroperitoneal and lateral pelvic lymphadenectomy. Lymphoscintigraphy using technetium-99 m-phytate and patent blue was performed to detect blue and/or radioactive retroperitoneal and/or lateral pelvic nodes which were examined histopathologically and immunohistochemically with a step-sectioning technique. RESULTS Mesorectal mean node count was 11.5 and retroperitoneal and/or lateral pelvic node was 11.7. Retroperitoneal and lateral pelvic lymphadenectomy identified metastases in 17.5%, upstaging 8.2%. Variables related to metastatic retroperitoneal and/or lateral pelvic nodes were the following: Stage III in total mesorectal excision specimens (P < 0.04), pT3/pT4 tumors (P = 0.047), high levels of carcinoembryonic antigen (P = 0.014) and large tumors (P = 0.03). Marker migration to retroperitoneal and/or lateral pelvic nodes occurred in 37.1%, upstaging 11.1%. The markers' accuracy in the detection of metastatic retroperitoneal and/or lateral pelvic nodes was 100%. CONCLUSIONS Retroperitoneal and lateral pelvic lymphadenectomy detected an important rate of metastatic retroperitoneal and/or lateral pelvic nodes (RLPN), resulting in upstaging. When markers migrated, they were able to detect RLPN metastases. The use of markers should be improved in the identification of RLPN metastases for selective indication of retroperitoneal and lateral pelvic lymphadenectomy.
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Quadros CA, Lopes A, Araujo I, Fregnani JH, Fahel F. Upstaging benefits and accuracy of sentinel lymph node mapping in colorectal adenocarcinoma nodal staging. J Surg Oncol 2008; 98:324-30. [PMID: 18618578 DOI: 10.1002/jso.21112] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Sentinel lymph node (SLN) mapping is an additional method for improving colorectal cancer nodal staging. The purpose of the study was to define the method's accuracy in nodal staging, its upstaging benefits and to identify the predictive factors for its failure. METHODS Lymphatic mapping was performed using technetium-99m-phytate and patent blue in 52 consecutive colorectal adenocarcinoma patients. Enhanced pathological examination was carried out on SLNs with hematoxylin-eosin step-sectioning and immunochemistry. RESULTS The patients studied had an average tumor size of 6.5 cm; 85% had T3/T4 tumors; and rectal tumors represented 57.7% of the group. Overall SLN mapping accuracy was 79.5%, with sensitivity of 65.2% and 34.8% false negatives. Upstaging with SLN mapping was 23.1%. Colon tumors had an SLN identification rate of 90.9% and rectal tumors had 63.3% (P = 0.023). Multivariate statistical analysis identified lower rectal tumor (P = 0.009), neoadjuvant treatment (P = 0.029) and tumor size (P = 0.036) as independent risk factors for the inability to detect SLNs. CONCLUSIONS Upstaging benefits of SLN mapping should be considered in colon and mid- and upper rectal tumors. The method should be avoided in patients with lower rectal tumors, large tumors and having had neoadjuvant therapy.
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Quadros CA, Lopes A, Araújo I, Fahel F, Bacellar MS, Dias CS. Retroperitoneal and Lateral Pelvic Lymphadenectomy Mapped by Lymphoscintigraphy and Blue Dye for Rectal Adenocarcinoma Staging: Preliminary Results. Ann Surg Oncol 2006; 13:1617-21. [PMID: 17009148 DOI: 10.1245/s10434-006-9116-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Revised: 05/21/2006] [Accepted: 05/23/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Total mesorectal excision (TME) is the standard surgical choice for rectal adenocarcinoma. Better prognostic results, achieved with a retroperitoneal and lateral pelvic lymphadenectomy (RLPL), have questioned that TME might not be satisfactory for adequate patient staging, affecting therapeutic definitions. The aims of the ongoing study are to define the accuracy of dye and probe search in the detection of metastatic retroperitoneal and lateral pelvic nodes (RLPN) resected with RLPL, and to evaluate the metastasis frequency in these nodes and its eventual upstaging impact. METHODS Thirty rectal adenocarcinoma patients were submitted to RLPL, with RLPN mapping using technetium (Tc 99 m) and patent blue, having nodes examined histopathologically and immunohistochemically. RESULTS Eight hundred and two nodes were analyzed, mean of 26.7 per patient; RLPL was responsible for 41% (330) of the examined nodes, mean of 11 per patient. Metastatic RLPN have occurred in 20% of the patients; the RLPN were metastatic in only 6.7% of the patients; RLPL upstaged 13.3%. For identification of metastatic RLPN with technetium, sensitivity was 33%, specificity 79%, positive predictor value (PPV) 29%, negative predictor value (NPV) 83% and false negative (FN) rate 67%. For patent blue and technetium metastatic RLPN identification, sensitivity was 17%, specificity 92%, PPV 33%, NPV 82% and FN 83%. CONCLUSIONS Preliminary results have pointed out technetium and blue dye low accuracy to identify metastatic RLPN; no metastatic RLPN were reported in the patients submitted to preoperative chemoradiation and important upstaging with RLPL. Considering no increase in morbi-mortality rates with RLPL, definitive conclusions will be obtained as the study carries on.
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Affiliation(s)
- Claudio Almeida Quadros
- Colorectal, Pathology and Nuclear Medicine Divisions, Aristides Maltez Cancer Hospital, Av. D. João VI, 332, Brotas, 40285-001, Salvador, Bahia, Brazil.
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11
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Quadros CA, Vasconcelos A, Andrade R, Ramos RS, Studart E, Nascimento G, Trajano A. Good outcome after neoadjuvant chemotherapy and extended surgical resection for a large radiation-induced high-grade breast sarcoma. Int Semin Surg Oncol 2006; 3:18. [PMID: 16824232 PMCID: PMC1538603 DOI: 10.1186/1477-7800-3-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 07/07/2006] [Indexed: 11/29/2022]
Abstract
This article is a case report of a high grade, radio-induced, breast malignant fibrous histiocytoma (undifferentiated high grade pleomorphic sarcoma), which developed in a 44-year old female, seven years after breast conservative surgery and radiotherapy for a T1N0M0 invasive left breast ductal carcinoma. The sarcoma presented as a fast growing tumour, 9.5 cm in the largest diameter, with skin, left breast, chest wall muscle and rib invasion. Neoadjuvant chemotherapy was performed with epirubicin and ifosfamide. Extended radical surgery according to oncological standards and soft tissue reconstruction were carried out. Despite bad prognostic features of high grade and large invasive sarcoma, the patient is currently, after 44 months of follow up, without local recurrence, or metastases, exceeding the 12.8-month mean recurrence period and mortality rate for these tumours larger than 8.1 cm (± 1.2 cm) as described in the literature.
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Affiliation(s)
| | | | - Roque Andrade
- Clinical Oncologist, Oncological Society of Bahia – ONCO, Salvador, Bahia, Brazil
| | | | - Eduardo Studart
- Pathologist, Silvany Studart Pathology Laboratory, Salvador, Bahia, Brazil
| | - Geraldo Nascimento
- Surgical Oncologist, Oncological Society of Bahia – ONCO, Salvador, Bahia, Brazil
| | - André Trajano
- Thoracic Surgeon, Portuguese Hospital, Salvador, Bahia, Brazil
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