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A análise conjunta do MELD pós-operatório, do base excess e dos níveis séricos de lactato pode ser usada como um índice prognóstico para pacientes submetidos a transplante de fígado? ABSTRACT PURPOSE:The objective of the present study was to evaluate the postoperative levels of classical or pure MELD and changes in lactate or base excess (BE) levels as possible predictive factors of the type of outcome of patients submitted to orthotopic liver trasplantation (OLT). METHODS:The study was conducted on 60 patients submitted to OLT at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, between October 2008 and March 2012. The 30 latest survivor (S) and non-survivor (NS) cases were selected.All liver transplants were performed using the piggy-back technique. ALT, AST, BE and blood lactate values were determined for each group at five time points (immediate preoperative period, end of hypothermal ischemia, 5 and 60 minutes after arterial revascularization and in the immediate postoperative period, when the postoperative MELD was also calculated. RESULTS:The aminotransferases reached a maximum increase 24 hours after surgery in both the S and NS groups. There was a significantly higher increase in BE and blood lactate in the NS group, especially after 5 minutes of afterial reperfusion of the graft, p<0.05. There was no significant difference in preoperative MELD between groups (p>0.05), while the postoperative MELD was higher in the NS than in the S group (p<0.05) CONCLUSION: Joint analysis of postoperative MELD, BE and blood lactate can be used as an index of severity of the postoperative course of patients submitted to liver transplantation. . Avaliou-se para cada grupo, os valores ALT, AST, de base excess (BE) e lactato sanguíneos em cinco momentos (pré-operatório imediato, no final da isquemia hipotérmica, 5 e 60 minutos após a revascularização arterial e no pós-operatório imediato, quando também foi calculado o MELD pós-operatório. RESULTADOS:Com relação às aminotransferases, houve um aumento máximo após 24 horas de pós-operatório em ambos os grupos S e NS. Houve aumento significativo dos níveis de BE e lactato sanguíneo significativamente maior no grupo NS, sobretudo nos tempos após 5 minutos de reperfusão arterial do enxerto, p<0,05. Não houve diferença significativa entre o MELD pré-operatório em ambos os grupos (p>0,05). O MELD pós-operatório foi maior no grupo NS do que no grupo S (p<0,05). CONCLUSÃO:A análise conjunta do MELD pós-operatório, do BE e do lactato sanguíneo pode ser usada como índice de gravidade da evolução pós-operatória de pacientes submetidos ao OLT.Descritores: Ácido Láctico, Transplante de Fígado, Índice de gravidade de doença, Prognóstico.

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Introduction: The neoadjuvant chemotherapy (NAC) approach can expressively influence radiation therapy indications after breast surgery by theoretically altering the loco-regional relapse risk in accordance with clinical stage features. Precisely, it could reduce this risk for a subgroup of patients with locally advanced breast cancer who achieved a good pathologic response after NAC. Thus, this might raise clinical questions of whether these more favorable subset of patients do benefit from PORT therapy or whether radiation should be performed only for patients with gross residual tumor after neoadjuvant chemotherapy. In addition, there are many uncertainties about the most appropriate radiation therapy fields in patients who received NAC given that all recommendations are usually based on initial clinical and pathological aspects. Objectives: The aim of the current study was to assess the radiation therapy fields and survival outcomes in breast cancer patients who underwent (NAC) followed by surgery. Methods: We performed a retrospective analysis of all non-metastatic breast cancer patients treated between 2008 and 2014 at our institution, who received NAC and post-operative radiation therapy (PORT). Results: A total of 528 women were included of whom 396 were submitted to mastectomy or adenomastectomy. Most (92.8%) of the patients had locally advanced disease (clinical stage IIB to IIIC). All patients underwent irradiation for breast or chest wall. Most patients received radiation therapy of the supraclavicular and axillary (levels II and III) nodes (87.1 and 86.4% for breast-conserving surgery and 95.1 and 93.8% for mastectomy / adenomastectomy, respectively). Irradiation of level I axillary and internal mammary nodes was uncommon. The most common radiation therapy schedule was the conventional dose of 50Gy to 50.4Gy in 25 to 28 fractions. The mean overall survival was 66.6 months and the mean disease-free survival was 54.6 months. Conclusions: After NAC, most patients received irradiation of the breast/chest wall and axillary and supraclavicular nodes. Indications were based on initial disease presentation associated with relapse risk factors. In this setting, post-operative radiation therapy to breast/chest wall with or without regional nodal irradiation was effective management that is associated with acceptable survival rates.