Erasto Gaertner Hospital

Curitiba, Brazil

Erasto Gaertner Hospital

Curitiba, Brazil
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Reichert Faria A.,Santa Casa Of Misericordia Of Curitiba Hospital | Reichert Faria A.,Pontifical Catholic University of Parana | Jung J.E.,Erasto Gaertner Hospital | Silva de Castro C.C.,Santa Casa Of Misericordia Of Curitiba Hospital | de Noronha L.,Pontifical Catholic University of Parana
Pathology Research and Practice | Year: 2017

Because defects in adhesion impairment seem to be involved in the etiopathogenesis of vitiligo, this study aimed to compare the immunohistochemical expression of several adhesion molecules in the epidermis of vitiligo and non lesional vitiligo skin. Sixty-six specimens of lesional and non lesional skin from 33 volunteers with vitiligo were evaluated by immunohistochemistry using anti-beta-catenin, anti-E-cadherin, anti-laminin, anti-beta1 integrin, anti-collagen IV, anti-ICAM-1 and anti-VCAM-1 antibodies. Biopsies of vitiligo skin demonstrated a significant reduction in the expression of laminin and integrin. The average value of the immunohistochemically positive reaction area of the vitiligo specimens was 3053.2 μm2, compared with the observed value of 3431.8 μm2 in non vitiligo skin (p = 0.003) for laminin. The immuno-positive area was 7174.6 μm2 (vitiligo) and 8966.7 μm2 (non lesional skin) for integrin (p = 0.042). A reduction in ICAM-1 and VCAM-1 expression in the basal layer of the epidermis in vitiligo samples was also observed (p = 0.001 and p < 0.001, respectively). However, no significant differences were observed with respect to the expression of beta-catenin, E-cadherin, and collagen IV between vitiligo and non lesional skin. Our results suggest that an impairment in adhesion exists in vitiligo skin, which is supported by the diminished immunohistochemical expression of laminin, beta1 integrin, ICAM-1 and VCAM-1. © 2017 Elsevier GmbH

Ribeiro R.,Erasto Gaertner Hospital | Rebolho J.C.,Erasto Gaertner Hospital | Tsumanuma F.K.,Onix Hospital | Brandalize G.G.,Onix Hospital | And 2 more authors.
Fertility and Sterility | Year: 2017

Objective: To report the first uterine transposition for fertility preservation in a patient with rectal cancer. Design: Case report. Setting: Community hospital. Patient(s): A 26-year-old patient with stage cT3N1M0 rectal adenocarcinoma located 5 cm from the anal margin. Intervention(s): Laparoscopic transposition of the uterus to the upper abdomen, outside of the scope of radiation, was performed to preserve fertility. After the end of radiotherapy, rectosigmoidectomy was performed and the uterus was repositioned into the pelvis. Main Outcome Measure(s): Uterine and ovarian function preservation. Result(s): The patient had two menstrual periods and exhibited normal variation in ovarian hormones throughout the course of neoadjuvant therapy. Menstruation began 2 weeks after reimplantation into the pelvis, and the cervix exhibited a normal appearance on clinical examination after 6 weeks. Eighteen months after the surgery, the uterus was normal and there was no sign of disease. Conclusion(s): Uterine transposition might represent a valid option for fertility preservation in women who require pelvic radiotherapy and want to bear children. However, studies that assess its viability, effectiveness, and safety are required. © 2017 American Society for Reproductive Medicine.

Braz-Silva P.H.,University of Sao Paulo | Santos R.T.M.,Adolfo Lutz Institute | Schussel J.L.,Erasto Gaertner Hospital | Gallottini M.,University of Sao Paulo
Cytopathology | Year: 2014

Objective: To establish a definitive diagnosis of oral hairy leukoplakia (OHL) by in situ hybridization for Epstein-Barr virus (EBV) detection with liquid-based cytology (LBC), using the ThinPrep® Pap Test, and to compare its efficacy with the traditional method of performing biopsy. Methods: Thirty-three individuals divided into three groups were included in this study. Group 1 consisted of 15 human immunodeficiency virus (HIV)-positive patients with a clinical and histopathological diagnosis of OHL on the lateral border of the tongue. Group 2 consisted of 10 HIV-positive individuals with neither OHL nor other oral lesions. Group 3 consisted of 10 immunocompetent HIV-negative individuals with neither OHL nor other oral lesions. For each patient from the three groups, exfoliative LBC was performed on the lateral border of the tongue using ThinPrep. For the patients from group 1, a 6-mm-diameter punch biopsy was obtained from the same anatomic site as the brush collection to confirm the diagnosis of OHL by histopathology with in situ hybridization. Slides were prepared for morphological cellular analysis using Papanicolaou (Pap) staining, and for EBV detection using in situ hybridization. Results: Thirteen of the 15 patients from group 1 were confirmed on punch biopsy as OHL, providing the gold standard for the study. The sensitivity of LBC followed by a Pap-stained smear was 62% and the specificity was 90%. The sensitivity of LBC followed by in situ hybridization was 100% and the specificity was 100%. Conclusions: Exfoliative LBC associated with EBV in situ hybridization is a simple, effective and non-invasive diagnostic tool for OHL. © 2013 John Wiley & Sons Ltd.

Carneiro N.K.,State University Londrina | Oda J.M.M.,State University Londrina | Losi Guembarovski R.,State University Londrina | Ramos G.,Erasto Gaertner Hospital | And 5 more authors.
International Journal of Immunogenetics | Year: 2013

Oral squamous cell carcinoma (OSCC) is a worldwide health problem because it is a great cause of cancer morbidity and mortality. The transforming growth factor-β1 (TGF-β1) is involved in the regulation of numerous immunomodulatory processes. Thus, the aim of this case-control study was to investigate the possible association between the TGF-β1T869C polymorphism and oral cancer. The genomic DNA extracted from peripheral blood of 62 male smoker patients diagnosed with OSCC and 62 smokers without cancer was analysed. The C allele was significantly more prevalent in the oral cancer group than in the controls, and individuals carrying this allele had an estimated 2.73-fold greater relative risk of developing cancer compared with C allele noncarriers (OR = 2.73, 95% CI = 1.19-6.28). Although T allele was not statistically significant among the controls, considering the genotypic analysis, the TT homozygous genotype showed a protector effect in relation to oral cavity cancer (OR = 0.37, 95% CI = 0.16-0.84). Some clinicopathological features were also analysed for genotype distribution, and no significant differences were observed: tumour size (P > 0.70), nodal status (P > 0.10) and tumour stage (P > 0.70). This is the first report of a study assessing the importance of T869C TGF-β polymorphism in oral cancer. It is known that the TGF-β T869C variation results in a Leu10Pro substitution in the signal peptide sequence. Our results suggested that the C allele could increase TGF-β secretion which suppresses antitumour immune responses and may affect the OSCC risk. © 2013 John Wiley & Sons Ltd.

Kluthcovsky A.C.G.C.,Federal University of Paraná | Urbanetz A.A.,Federal University of Paraná | De Carvalho D.S.,Federal University of Paraná | Maluf E.M.C.P.,Federal University of Paraná | And 2 more authors.
Supportive Care in Cancer | Year: 2012

Purpose Fatigue is a phenomenon that may persist for years after completion of adjuvant therapy, and is one of the most frequent symptoms associated with breast cancer survivors. The purposes of this study were to investigate the occurrence of fatigue in disease-free breast cancer survivors after treatment, to identify variables associated with fatigue, and to evaluate the impact of fatigue on health-related quality of life. Methods A cross-sectional study was conducted on 202 consecutive women diagnosed with in-situ to Stage III breast cancer attending in outpatient facilities of two large hospitals, one year or more after diagnosis. They completed the Piper Fatigue Scale-Revised and the European Organization for Research and Treatment of Cancer QLQ-C30. Multiple logistic regression models were used to identify predictive factors associated with fatigue. EORTC QLQC-30 scores for fatigued survivors were compared to non-fatigued survivors. Results The prevalence of fatigue reported by the breast cancer survivors was 37.6%. Multiple logistic regression analysis revealed that predictive factors for fatigue included younger age (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.11-4.45, p=0.024); presence of pain (OR=3.87, 95% CI=1.88-7.98, p=0.000); dyspnea (OR=3.72, 95% CI= 1.46-9.50, p=0.006); insomnia (OR=2.40, 95% CI=1.19-4.86, p=0.015); and nausea and vomiting (OR=12.25, 95% CI=1.18-126.75, p=0.036). Fatigued women had poorer health-related quality of life than non-fatigued women in all domains. Conclusion Our results suggest that many disease-free breast cancer survivors after treatment experienced fatigue that compromises their health-related quality of life. © 2011 Springer-Verlag.

PubMed | Federal University of Paraná, Erasto Gaertner Hospital and University of Sao Paulo
Type: Journal Article | Journal: International archives of otorhinolaryngology | Year: 2015

Radiotherapy (RT) of head and neck neoplasms often damages the salivary glands.To examine the pattern of morphologic changes resulting from RT of the head and neck region in minipig parotid glands in a clinical and experimental research setting.Twelve 18-month-old male Brazilian minipigs weighing 30-40kg were selected. Eight minipigs were assigned to the experimental group (group 1) and 4 to the control group (group 2). The RT was performed under general anesthesia at Erasto Gaertner Hospital, Curitiba, Brazil, using an / ratio of 2.5. The minipigs from group 1 underwent 3 sessions of irradiation with Cobalt 60 of the head and neck, bilaterally, with 3 exposures of 8Gy each at 7-day intervals for a total dose of 24 Gy. The animals were sacrificed 12 weeks post-RT.The irradiated parotid glands displayed reductions in the size and number of acini as well as loss of secretory granules. The presence of fibrosis and loss of parenchyma relative to non-irradiated glands were observed, with an average reduction in volume of 54%.Our results demonstrate that this model for parotid gland damage resulting from an RT regimen appears to be useful for preclinical large animal studies of RT-induced damage and testing novel potential treatment options. Although recent advances in radiation therapy, such as intensity-modulated radiation therapy, have reduced the dose and limited the field of radiation, considerable salivary gland injury still occurs and can greatly impact the patients quality of life after cancer treatment.

Petruzziello A.,Erasto Gaertner Hospital | Kondo W.,VITA Batel Hospital | Hatschback S.B.,Erasto Gaertner Hospital | Guerreiro J.A.,Erasto Gaertner Hospital | And 4 more authors.
World Journal of Surgical Oncology | Year: 2014

Background: Our aim in the present study was to evaluate surgical outcomes and complications of pelvic exenteration in the treatment of gynecologic malignancy and to compare surgery-related complications associated with different types of exenteration.Methods: We performed a retrospective analysis of patients who underwent pelvic exenteration for the treatment of gynecologic cancer between January 2008 and August 2011. Patients were divided into two groups for comparison: total pelvic exenteration (TPE) and nontotal pelvic exenteration (NTE, including anterior pelvic exenteration (APE) posterior pelvic exenteration (PPE)). Outcomes are reported according to the modified Clavien-Dindo Classification of Surgical Complications.Results: Twenty-eight patients were included in the analysis. Eighteen had cervical cancer (64.3%). The prevalence of stage IIIB cervical cancer was 55%. Primary treatment with radiotherapy was performed in 53.3% of patients. Fifty percent of patients underwent TPE, 25% had APE and 25% underwent PPE. Patients who underwent TPE had worse outcomes, with a mean operative time of 367 minutes, use of blood transfusion in 93% of patients, ICU stay of 4.3 days and total hospital stay of 9.4 days. The overall mortality rate was 14.3%, and the surgical site infection rate was 25%. In the TPE group, 78.6% of patients experienced surgical complications. One-fourth of the total patient sample required reoperation, and the leading cause was urinary fistula (57.1%). Urinary leakage occurred in 22.7% of urinary reconstruction patients. Wet colostomy was the most common form of reconstruction with 10% of leakage.Conclusions: Postoperative urinary and infectious complications accounted for 75% of all causes of morbidity and mortality after pelvic exenteration. TPE is a more complex and morbid procedure than NTE. © 2014 Petruzziello et al.; licensee BioMed Central Ltd.

Preti V.,Washington Hospital Center | Preti V.,Erasto Gaertner Hospital | Chang D.,Westat | Sugarbaker P.H.,Washington Hospital Center
Gastroenterology Research and Practice | Year: 2012

Cytoreductive surgery (CRS) with hyperthermic perioperative chemotherapy (HIPEC) has become a treatment option for selected patients with peritoneal metastases (PMs) from gastrointestinal malignancies. The purpose of this study is to evaluate our most recent data regarding pulmonary complications (respiratory distress, pleural effusion, and pneumonia) and attempt to identify risk factors associated with this management plan. This study includes the most recent 4-year experience with appendiceal and colorectal carcinomatosis patients treated in a uniform manner between January 1, 2006 and December 31, 2009. A prospective morbidity and mortality database was maintained and pulmonary adverse events were analyzed with special attention to subphrenic peritonectomy. There were 147 consecutive patients with a mean age of 49.9 years. Fourteen patients (10) presented grades IIV pulmonary complications for a total of 26 events. The peritonectomy of right upper quadrant was performed in 74 and right plus left in 49 of the patients. Statistically, there were no more pulmonary complications among patients submitted to peritoneal stripping of right or right and left hemidiaphragm as compared to no subdiaphragmatic peritonectomy (P = 1.00 and P = 0.58, resp.). In an analysis of 18 quantitative indicators and clinical variables with pulmonary adverse events, only blood replacement greater than six units showed a significant correlation (P = 0.0062). Pulmonary adverse events were observed in 10 of patients having CRS and HIPEC. Subphrenic peritonectomy was not a specific risk factor for developing these adverse events. © 2012 Vinicius Preti et al.

PubMed | Erasto Gaertner Hospital
Type: Journal Article | Journal: Asian Pacific journal of cancer prevention : APJCP | Year: 2016

Objective: This article concerns evaluation of the sensitivity, specificity and accuracy of FNAB for pre-surgical diagnosis of benign and malignant lesions of major and minor salivary glands of patients treated in the Department of Head and Neck Surgery of Erasto Gartner Hospital. Methods: This retrospective study analyzed medical records from January 2006 to December 2011 from patients with salivary gland lesions who underwent preoperative FNAB and, after surgical excision of the lesion, histopathological examination. Results: The study had a cohort of 130 cases, but 34 cases (26.2%) were considered unsatisfactory regarding cytology analyses. Based on the data, sensitivity was 66.7% (6/9), specificity was 81.6% (71/87), accuracy was 80.2% (77/96), the positive predictive value was 66,7% (6/9) and the negative predictive value was 81.6% (71/87). Conclusion: Despite the high rate of inadequate samples obtained in the FNAB in this study the technique offers high specificity, accuracy and acceptable sensitivity.

PubMed | Erasto Gaertner Hospital
Type: Journal Article | Journal: Oral and maxillofacial surgery | Year: 2016

Osteoradionecrosis is a complication of head and neck radiotherapy, with a difficult resolution and no well-established treatment. The disease progression can cause important loss on patients quality of life after cancer treatment. The options for treatment are limited and include clinical monitoring, prescription, or surgical procedures. As an alternative for bone necrosis treatment, a combination of drugs, pentoxifylline and tocopherol, can be used. Studies have shown that this combination significantly reduces chronic radiotherapy damage. The article reports successful treatment with this prescription protocol.We report three cases of patients referred to the Service of Oral and Maxillofacial Surgery at Erasto Gaertner Hospital, in Curitiba, Brazil. They were submitted to radiotherapy for the treatment of malignant head and neck tumors and later developed osteoradionecrosis. They were treated with the combination pentoxifylline and tocopherol.All patients achieved complete remission in less than 1year, with complete healing of bone exposure and without clinical symptoms.This results show that this combination of drugs is beneficial in cases of bone necrosis induced by radiation, avoiding more aggressive treatments and reducing morbidity.

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