No abstract

Objective: To evaluate and discuss the indications for breast magnetic resonance imaging in an oncology reference center. Materials and Methods: Retrospective study approved by the Committee for Ethics in Research of the institution and developed through a review of patients' records and clinical reports. All the breast magnetic resonance studies performed in the period from July 2008 to July 2009 (n = 529) were included. Results: Mean patients' age was 49 years, ranging from 17 to 86 years. Family history of breast and/or ovarian cancer was present in 162 patients (30.6%). Most common indications for breast magnetic resonance imaging included inconclusive mammographic/sonographic findings (48.8%), evaluation of tumor recurrence/surgical scar after breast surgery (15.1%), disease staging/surgical planning (11.7%) and screening in high-risk patients (8.5%). Conclusion: In spite of inconclusive findings at conventional imaging studies being the most common indication for breast magnetic resonance imaging, there is no evidence in the literature supporting such a conduct. Because of its high sensitivity and high rate of false positive results, magnetic resonance imaging should be appropriately indicated in order to avoid unnecessary procedures. Once such method is appropriately indicated, it may contribute in the decision making process, constituting an essential tool in the assessment of breast lesions. Keywords: Magnetic resonance imaging; Breast neoplasms; Early detection of cancer.Objetivo: Avaliar e discutir as indicações de ressonância magnética das mamas em um centro de referência oncoló-gico. Materiais e Métodos: Estudo retrospectivo, aprovado pelo Comitê de Ética e Pesquisa da instituição, conduzido através da revisão de prontuários e laudos médicos. Foram incluídos todos os exames de ressonância magnética das mamas realizados no período de julho de 2008 a julho de 2009 (n = 529). Resultados: A idade média das pacientes foi de 49 anos, variando de 17 a 86 anos. História familiar de câncer de mama e/ou ovário esteve presente em 162 pacientes (30,6%). As indicações mais comuns de ressonância magnética das mamas foram esclarecimento de achados inconclusivos na mamografia e/ou ultrassom (48,8%), avaliação de recorrência tumoral/cicatriz cirúrgica (15,1%), estadiamento/planejamento cirúrgico (11,7%) e rastreamento de pacientes de alto risco (8,5%). Conclusão: Apesar de achados inconclusivos nos exames convencionais serem a indicação mais comum de ressonância magnética das mamas, não há evidências que justifiquem esta conduta na literatura. Em razão da sua alta sensibilidade e percentual de falso-positivos, este exame deve ser adequadamente indicado, para evitar a realização de procedimentos desnecessários. Se bem indicada, a ressonância magnética pode contribuir para o processo de tomada de decisão e constitui uma ferramenta fundamental na avaliação de lesões mamárias. Unitermos: Imagem por ressonância magnética; Neoplasias da mama; Detecção precoce de câncer. AbstractResumo

BackgroundThe association of preoperative systemic and intraperitoneal chemotherapy has been described in Eastern patients with very good outcomes in treatment responders. The aim of this paper is to describe the initial results of this multidisciplinary regimen in gastric cancer patients with very advanced peritoneal metastases.Case presentationWe present here the first four cases who received the treatment protocol. They had a baseline PCI between 19 and 33. Two patients had received systemic chemotherapy prior to this regimen. Three of them had significant response and were taken to cytoreductive surgery, while one patient who had 12 cycles of chemotherapy previously showed signs of disease progression and subsequently died. There was no significant postoperative morbidity, and three patients remain alive, two of them with no signs of recurrence.ConclusionSystemic and intraperitoneal chemotherapy led to a marked response in peritoneal disease extent in our initial experience and allowed three of four patients with very advanced disease to be treated with cytoreductive surgery.

Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.Keywords: gunshot wounds; embolism; aorta. ResumoA embolização por projétil de arma de fogo na circulação sanguínea é rara e de difícil suspeição no atendimento inicial ao trauma. Relatamos e discutimos um caso de embolia em bifurcação aórtica abdominal complicada com pesudoaneurisma de aorta tóraco-abdominal e oclusão de artéria ilíaca comum direita, tratada de forma efetiva pelos métodos endovascular e cirúrgico convencional.Palavras-chave: ferimentos por arma de fogo; embolismo; aorta.

Background: Chronic obstructive pulmonary disease (COPD) is related to the prognosis of patients with lung cancer, and one of risk factors of respiratory complications after surgical resections. This study aimed to investigate whether perioperative inhalations of long-acting beta-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) would decrease the postoperative complications in lung cancer patients with COPD. Methods:We retrospectively analyzed 108 patients with COPD who underwent pulmonary resections for primary lung cancer at our hospital between January 2013 and January 2016, in order to determine the association between the incidence of postoperative complications (e.g., prolonged air leakage and pneumonia) and the use of LABAs or LAMAs. Results: Among 108 patients with COPD patients, there were 86 men and 22 women, with a mean age of 69.3 years (range, 46e84). The mean Brinkman index was 1172.1(range, 50-3480). The mean FEV1.0/FVC was 61.4%(range, 26.8%-69.9%). The surgical procedures were partial resection in 11 patients, pulmonary segmentectomy in 3 patients, lobectomy in 92 patients, and pneumonectomy in 2 patients. The histological types showed adenocarcinoma in 53 patients, squamous cell carcinoma in 38 patients, adenosquamous carcinoma in 5 patients, large cell neuroendocrine carcinoma in 3 patients, large cell carcinoma in 4 patients, small cell carcinoma in one patient, and pleomorphic carcinoma in 4 patients. There were 29 postoperative complications in COPD (26.9%), prolonged air leak (more than 7 days) 14 cases, pneumonia 9 cases, arrhythmia 2 cases, chylothorax 2 cases, wound infection 2 cases. The frequency of postoperative pulmonary complications such as prolonged air leakage and pneumonia, was significant higher in COPD (23 cases, 21.3%) than in non COPD (15 cases,6.7%). Inhaled bronchodilators such as LAMA or LABA were prescribed to 34 cases in COPD, not to 74 cases. The pulmonary complications were significant lower in LAMA or LABA users (3 cases, 8.8%) than in no users (20 cases, 27.0%). Conclusion:For lung cancer patients with COPD, preoperative management using the inhalants with LABA or LAMA, and smoking cessation can reduce the frequency of the postoperative pulmonary complications after surgical lung resection. The inhalants with LAMA or LABA may be adapted for the management of not only perioperative care but also long-term survival of COPD patients after surgery.Background: There is no consensus about the best method to follow up patients after complete resection of lung cancer. This study was performed to identify how often follow-up chest-CT detected recurrence or a second primary lung cancer in asymptomatic patients.

No abstract

Background: Combined cytotoxic T-lymphocyte-associated antigen 4 and programmed death 1 inhibitor blockade is a promising strategy in advanced melanoma and other solid tumors. This pilot study assessed the safety and toxicity of nivolumab plus low-dose ipilimumab in patients with high-risk completely resected melanoma.Patients and Methods: Patients received ipilimumab, 1 mg/kg every 6 weeks, and nivolumab, 3 mg/kg every 2 weeks, for a total of 24 weeks (4 cycles). The primary objective was to assess the toxicity of the combined regimen.Results: Twenty-one patients with resected melanoma were enrolled. One patient was stage IIC, 16 patients were stage III and 4 patients had resected stage 4 disease. Ten of 21 (48%) had grade 3 treatment-related toxicities but there was no grade 4 or grade 5 toxicities. The rate of grade 3 nonhematologic toxicities exceeded the toxicity limits defined by the study. Fifteen of 21 patients (71%) completed all 4 cycles of therapy. The median follow-up is 41 months. The 2-year recurrencefree survival is 85.7% and the 2-year overall survival is 90.5%. Conclusion:A 6-month course of nivolumab and low-dose ipilimumab may be a promising adjuvant treatment for patients with resected melanoma. Further studies of this regimen are indicated.

Objective: To report the experience of a routine follow-up program based on medical visits and chest CT. Methods: This was a retrospective study involving patients followed after complete surgical resection of non-small cell lung cancer between April of 2007 and December of 2015. The follow-up program consisted of clinical examination and chest CT. Each follow-up visit was classified as a routine or non-routine consultation, and patients were considered symptomatic or asymptomatic. The outcomes of the follow-up program were no evidence of cancer, recurrence, or second primary lung cancer. Results: The sample comprised 148 patients. The median time of follow-up was 40.1 months, and 74.3% of the patients underwent fewer chest CTs than those recommended in our follow-up program. Recurrence and second primary lung cancer were found in 17.6% and 11.5% of the patients, respectively. Recurrence was diagnosed in a routine medical consultation in 69.2% of the cases, 57.7% of the patients being asymptomatic. Second primary lung cancer was diagnosed in a routine medical appointment in 94.1% of the cases, 88.2% of the patients being asymptomatic. Of the 53 patients who presented with abnormalities on chest CT, 41 (77.3%) were diagnosed with cancer. Conclusion: Most of the cases of recurrence, especially those of second primary lung cancer, were confirmed by chest CT in asymptomatic patients, indicating the importance of a strict follow-up program that includes chest CTs after surgical resection of lung cancer.