Brazil has an important role in the biomass burning, with the detection of approximately 100,000 ... more Brazil has an important role in the biomass burning, with the detection of approximately 100,000 burning spots in a single year (2007). Most of these spots occur in the southern part of the Amazon basin during the dry season (from August to november) and these emissions reach the southeast of the country, a highly populated region and with serious urban air pollution problems. With the growing demand on biofuels, sugarcane is considerably expanding in the state of Sao Paulo, being a strong contributor to the bad air quality in this region. In the state of Sao Paulo, the main land use are pasture and sugarcane crop, that covers around 50% and 10% of the total area, respectively. Despite the aerosol from sugarcane burning having reduced atmospheric residence time, from a few days to some weeks, they might get together with those aerosol which spread over long distances (hundreds to thousands of kilometers). In the period of June through February 2010 a LIDAR observation campaign was carried in the state of Sao Paulo, Brazil, in order to observe and characterize optically the aerosols from two distinct sources, namely, sugar cane biomass burning and industrial emissions. For this purpose 2 LIDAR systems were available, one mobile and the other placed in a laboratory, both working in the visible (532 nm) and additionally the mobile system had a Raman channel available (607 nm). Also this campaign counted with a SODAR, a meteorological RADAR specially set up to detect aerosol "echoes" and gas-particle analyzers. To guarantee a good regional coverage 4 distinct sites were available to deploy the instruments, 2 in the near field of biomass burning activities (Rio Claro and Bauru), one for industrial emissions (Cubatao) and others from urban sources (Sao Paulo). The whole campaign provide the equivalent of 30 days of measurements which allowed us to get aerosol optical properties such as backscattering/extinction coefficients, scatter and LIDAR ratios, those were used to correlate with air quality and meteorological indicators and quantities. In this paper we should focus on the preliminary results of the Raman LIDAR system and its derived aerosol optical quantities.
Background and aims. Metastatic spread of a distant tumor to the rectum is extremely rare. To our... more Background and aims. Metastatic spread of a distant tumor to the rectum is extremely rare. To our knowledge, there have been no published reports of hematogenic metastasis from a renal cell carcinoma to the rectum. Patients and methods. A patient with a renal cell carcinoma was initially treated by a radical right nephrectomy. Results. Nine months after the surgery he started to have multiple episodes of hematochezia. Colonoscopy showed a nodular lesion located in the distal rectum, and biopsy revealed an undifferentiated carcinoma. The patient then underwent abdominoperineal resection of the rectum, and histological examination showed metastatic renal clear cell carcinoma. Conclusion. This case represents an exceedingly rare condition, which has never been reported before.
PURPOSE: This study was conducted to assess the feasibility of the sentinel lymph node procedure ... more PURPOSE: This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. METHODS: Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). RESULTS: Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. CONCLUSIONS: The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.
Ewing sarcoma is a rare and lethal malignant bone tumor, mostly affecting young male patients, an... more Ewing sarcoma is a rare and lethal malignant bone tumor, mostly affecting young male patients, and has a predilection for the femur, tibia, pelvis, and humerus. Based on the use of improved staging systems, chemotherapy, radiation, and resective surgery, actually most patients live and retain function of their limbs. The concept of limb-sparing surgery has evolved over the last three decades and has become as effective as amputation in treating extremity sarcoma. Many centers have abandoned traditional reconstruction with avascular allografts, resection arthrodesis in favor of metallic endoprosthesis, or fibula free flap for long bone defects. The ipsilateral fibular pedicled flap is an excellent choice for tibial, large, segmental defects reconstruction, because it has a low rate of infection and malunion; the functional outcome is good and avoids contralateral donor site morbidity, and it is less time-consuming than free fibula flap. It also provides the advantage of one-stage reconstruction. We report a case of a 12-year-old patient with history of Ewing sarcoma on the 1/3 of the upper tibia. The bone defect after tumor excision was 12 cm; the flap was dissected until the vascular pedicle, rotated to 180°, and fixed with plate in T and screws. The patient had successful bone union and achieved good functional results at the end of the 1-year follow-up period. Full weight-bearing was achieved within 7 months. This technique should be considered for reconstructing large and complex bone defects resulting from tumor extirpation.
Brazil has an important role in the biomass burning, with the detection of approximately 100,000 ... more Brazil has an important role in the biomass burning, with the detection of approximately 100,000 burning spots in a single year (2007). Most of these spots occur in the southern part of the Amazon basin during the dry season (from August to november) and these emissions reach the southeast of the country, a highly populated region and with serious urban air pollution problems. With the growing demand on biofuels, sugarcane is considerably expanding in the state of Sao Paulo, being a strong contributor to the bad air quality in this region. In the state of Sao Paulo, the main land use are pasture and sugarcane crop, that covers around 50% and 10% of the total area, respectively. Despite the aerosol from sugarcane burning having reduced atmospheric residence time, from a few days to some weeks, they might get together with those aerosol which spread over long distances (hundreds to thousands of kilometers). In the period of June through February 2010 a LIDAR observation campaign was carried in the state of Sao Paulo, Brazil, in order to observe and characterize optically the aerosols from two distinct sources, namely, sugar cane biomass burning and industrial emissions. For this purpose 2 LIDAR systems were available, one mobile and the other placed in a laboratory, both working in the visible (532 nm) and additionally the mobile system had a Raman channel available (607 nm). Also this campaign counted with a SODAR, a meteorological RADAR specially set up to detect aerosol "echoes" and gas-particle analyzers. To guarantee a good regional coverage 4 distinct sites were available to deploy the instruments, 2 in the near field of biomass burning activities (Rio Claro and Bauru), one for industrial emissions (Cubatao) and others from urban sources (Sao Paulo). The whole campaign provide the equivalent of 30 days of measurements which allowed us to get aerosol optical properties such as backscattering/extinction coefficients, scatter and LIDAR ratios, those were used to correlate with air quality and meteorological indicators and quantities. In this paper we should focus on the preliminary results of the Raman LIDAR system and its derived aerosol optical quantities.
Background and aims. Metastatic spread of a distant tumor to the rectum is extremely rare. To our... more Background and aims. Metastatic spread of a distant tumor to the rectum is extremely rare. To our knowledge, there have been no published reports of hematogenic metastasis from a renal cell carcinoma to the rectum. Patients and methods. A patient with a renal cell carcinoma was initially treated by a radical right nephrectomy. Results. Nine months after the surgery he started to have multiple episodes of hematochezia. Colonoscopy showed a nodular lesion located in the distal rectum, and biopsy revealed an undifferentiated carcinoma. The patient then underwent abdominoperineal resection of the rectum, and histological examination showed metastatic renal clear cell carcinoma. Conclusion. This case represents an exceedingly rare condition, which has never been reported before.
PURPOSE: This study was conducted to assess the feasibility of the sentinel lymph node procedure ... more PURPOSE: This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. METHODS: Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). RESULTS: Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. CONCLUSIONS: The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.
Ewing sarcoma is a rare and lethal malignant bone tumor, mostly affecting young male patients, an... more Ewing sarcoma is a rare and lethal malignant bone tumor, mostly affecting young male patients, and has a predilection for the femur, tibia, pelvis, and humerus. Based on the use of improved staging systems, chemotherapy, radiation, and resective surgery, actually most patients live and retain function of their limbs. The concept of limb-sparing surgery has evolved over the last three decades and has become as effective as amputation in treating extremity sarcoma. Many centers have abandoned traditional reconstruction with avascular allografts, resection arthrodesis in favor of metallic endoprosthesis, or fibula free flap for long bone defects. The ipsilateral fibular pedicled flap is an excellent choice for tibial, large, segmental defects reconstruction, because it has a low rate of infection and malunion; the functional outcome is good and avoids contralateral donor site morbidity, and it is less time-consuming than free fibula flap. It also provides the advantage of one-stage reconstruction. We report a case of a 12-year-old patient with history of Ewing sarcoma on the 1/3 of the upper tibia. The bone defect after tumor excision was 12 cm; the flap was dissected until the vascular pedicle, rotated to 180°, and fixed with plate in T and screws. The patient had successful bone union and achieved good functional results at the end of the 1-year follow-up period. Full weight-bearing was achieved within 7 months. This technique should be considered for reconstructing large and complex bone defects resulting from tumor extirpation.
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Papers by Andres Gilberto