Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology.

BACKGROUND: Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. METHODS: Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. RESULTS: Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. CONCLUSION: Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.

Population-based study: breast cancer mortality trend in women in the state of Paraná from 2000 to 2017

Objective: Breast cancer is one of the main challenges in Brazilian public health due to the high associated mortality. Mortality has different patterns according to age group, usually increasing with age. The demographic stability in Paraná, with the growth of the elderly population, has a direct impact on the epidemiology of this disease. This study aimed to assess, on a population-based basis, the rates and trends of mortality from breast cancer among the age groups of women in the state of Paraná from 2000 to 2017. Methods: A statistical descriptive retrospective series study was carried out to analyze, on a population-based basis, the trend in breast cancer mortality rates among the age groups of women in the state of Paraná, from 2000 to 2017. The trend analysis of annual mortality rates was carried out through the software and simple linear regression models. Results: The population-based analysis showed that women aged 45­54 and 55­64 years had the highest number of deaths during the study period. However, when calculating the mortality rates by age group, it was observed that the mortality pattern increases proportionally to the longevity of the female population in the state. Trend analyses indicated an upward trend in mortality among women aged 25­34 years throughout the study period. The same trend was observed in women aged 35­44 years, but in a shorter period, from 2005 to 2017. Conclusion: Mortality rates, per 100,000 women, were directly proportional to age, increasing with age, indicative of greater mortality from the disease in elderly women. There was a trend of increasing mortality, with statistical significance, in the age groups from 25 to 34 and 35 to 44. The others were considered stable trends.

Analysis of bilateral breast carcinomas: a profile of patients at a reference service

Objective: To select cases of bilateral breast carcinoma (BBC) of patients seen at Hospital de Clínicas of Paraná, besides recognizing clinical and family characteristics, histological and immunohistochemical pattern, and incidences of synchronic/metachronic tumor in these patients. Method: Observational and analytical study of BBC cases of patients treated at Hospital de Clínicas of Paraná, from 2003 to 2019, developed from the analysis of medical records. Result: A total of 42 patients with BBC were selected. The incidence of BBC was 3.64%. All patients were women, mostly of white skin color and postmenopausal, with an average age of 51.82 years. Half patients showed a positive family history for cancer, with breast cancer present in 46%, ovarian cancer in 16%, and other topographies in 68%. In this sample, the synchronous tumor was present in 55% of patients, and the metachronous tumor, in 45%. Regarding patients' initial clinical staging, 61% had a locally advanced tumor at diagnosis. Both in the group of synchronic and metachronic tumors, the ductal subtype was the most frequent. Regarding the immunohistochemical subtype, patients in both groups had Luminal B tumors more frequently. In the group of metachronic tumors, the average time between the diagnosis of the first tumor and the second tumor was 5.68 years. Conclusion: In this sample, BBC is associated with a relevant family history, with a synchronic presentation pattern, from histology to ductal and immunohistochemistry to Luminal B as the most frequent.

Marking axillary nodes with 4% carbon microparticle suspension before neoadjuvant chemotherapy improves sentinel node identification rate and axillary staging.

BACKGROUND AND OBJECTIVES: Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. METHODS: A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. RESULTS: Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). CONCLUSION: The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.

Invasive lobular carcinomas treated at Hospital de Clínicas of UFPR: incidence, characteristics and clinical outcome / Carcinomas lobulares invasores de mama tratados no Hospital de Clínicas da UFPR: incidência, características e evolução clínica

Objective: The aim of this study is to depict the clinical and epidemiological profile of patients treated for invasive lobular carcinoma (ILC) at Hospital das Clínicas of Universidade Federal do Paraná (HC-UFPR) over the course of ten years and to evaluate the variation of ILC dimensions on imaging exams by comparing them to real-size lesions identified in surgical specimens. Methods: Patients undergoing breast surgical procedures at HC-UFPR from 2005 to 2014 were selected. Out of these, 36 were diagnosed with ILC and had their medical files sought after clinical, epidemiological, therapeutic and prognosis characteristics. The variance of tumor sizes in imaging methods and anatomopathological descriptions were also studied. Results: Patients' mean age at diagnosis was 59.6 years. Most of them were classified as clinical stages II (40%) and III (26.7%) by the time they were diagnosed. The majority of tumors were HER2 negative (77.2%) and estrogen-receptor positive (90%). The surgical treatment was radical in 74.2% of the cases. 31.4% of the patients underwent both mammography and ultrasonography screening and 45.7% underwent only one of them. None of the patients were submitted to magnetic resonance imaging (MRI). Conclusion: Data found about patients with invasive lobular carcinoma at HC-UFPR is in accordance with the medical literature, including incidence rates and tumor characteristics. The variance of tumor sizes in imaging exams and surgical specimen was not statistically significant

Objetivo: O estudo busca caracterizar o perfil clínico epidemiológico referente às pacientes tratadas por carcinoma lobular invasor de mama (CLI) no Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) em um período de dez anos e avaliar as variações das dimensões dos CLI nos exames de imagem quando comparadas ao real tamanho das lesões identificadas nas peças de anatomia patológica. Métodos: Foram selecionadas pacientes submetidas a procedimentos cirúrgicos de mama no HC-UFPR entre os anos de 2005 e 2014, dentre as quais 36 apresentaram diagnóstico de CLI. Seus prontuários foram analisados para avaliação de características clínicas, epidemiológicas, terapêuticas e prognósticas. Também foi avaliada a discrepância dos valores de tamanho do tumor em métodos de imagem em relação ao descrito nos laudos anatomopatológicos. Resultados: A s p acientes c om d iagnóstico d e C LI tinham média de idade no diagnóstico de 59,6 anos. O diagnóstico foi feito, em sua maioria, nos estádios clínicos II (40%) e III (26,7%). Houve maior negatividade (77,2%) para HER2 e positividade (90%) para receptor de estrógeno. O tratamento cirúrgico foi radical em 74,2% das pacientes. Em exames de imagem, 31,4% das pacientes realizaram mamografia e ultrassonografia em conjunto, 45,7% fizeram apenas um dos exames e nenhuma realizou ressonância magnética. Conclusão: Observou-se que a casuística de patologias mamárias do HC-UFPR está de acordo com a literatura em relação à incidência e às características próprias dos CLI. A análise da discrepância dos tamanhos dos tumores em exames de imagem em relação às peças cirúrgicas não obteve resultados significativos estatisticamente

Charcoal granuloma mimicking breast cancer: an emerging diagnosis.

BACKGROUND: Image-guided charcoal injection in suspicious breast lesions for preoperative localization is a procedure that has been increasing over the years because it is safer, faster, and more affordable when compared to needle-wire preoperative localization. To date, no complications have been associated with the method. However, in recent years there have been some reports about charcoal granulomas mimicking malignant lesions in some postoperative patients or in a conservative follow-up. PURPOSE: To report a series of 11 cases which had suspicious imaging findings for malignancy and resulted in charcoal granulomas on histopathological analysis. MATERIAL AND METHODS: A database of 1650 patients that attended our center from January 2007 to June 2018 was reviewed and detected 495 patients who had been previously submitted to ultrasound-guided charcoal marking in a breast lesion. Then, patients whose imaging studies were compatible with new suspicious lesions on mammography, breast ultrasound, and/or magnetic resonance imaging and biopsy of this new lesion indicating charcoal granuloma were selected. RESULTS: From 495 patients who had undergone charcoal localization injections in previous biopsies, we selected 11 who had new lesions with malignant characteristics on imaging studies but histopathological analysis resulted in charcoal granuloma. CONCLUSION: Charcoal granuloma should be considered in patients with previous preoperative injection localization, since the residual charcoal in the breast tissue may form granulomas and mimic malignant lesions on follow-up imaging studies.

Avaliação do índice de cesarianas e partos normais em hospital de referência em gravidez de alto risco de Curitiba / Cesarean sections and vaginal deliveries index assessment in a reference hospital for high risk pregnancy in Curitiba

Objetivos: Avaliar a incidência de cesarianas e partos normais em um hospital de referência em alto risco gestacional. Além disso, avaliar as condições clínicas que implicam em um maior risco de realização de cesarianas. Métodos: Foram avaliados dados dos registros do Centro Cirúrgico Obstétrico do Hospital Universitário Evangélico de Curitiba, nos quais consta a totalidade de nascimentos no período de abril de 2013 a abril de 2014. Foram consideradas as seguintes variáveis nos grupos P (parto normal) e C (cesarianas): distocia, frequência cardíaca fetal (FCF) não tranquilizadora, idade gestacional ecográfica, gemelaridade, diabetes mellitus gestacional, síndromes hipertensivas (doença hipertensiva específica da gravidez, pré-eclâmpsia e hipertensão arterial sistêmica), infecção de trato urinário de repetição, idade da gestante, iteratividade, hipotireoidismo, número de gestações, partos e cesarianas prévias. A análise estatística foi realizada através dos testes t de Student, não-paramétrico de Mann-Whitney para variáveis quantitativas e do teste Qui-Quadrado para variáveis qualitativas. Valores de p < 0,05 indicaram significância estatística. Resultados: Do total de 2617 nascimentos no período o número de partos normais correspondeu a 1471, representando 56,2% e o de cesarianas 1146, representando 43,8%. As taxas de cesarianas mostraram-se significativas, configurandose como fator de risco para sua realização nas variáveis: iteratividade (grupo P=2; C=234; OR=188,9), DMG (grupo P=183; C=230; OR=1,77), obesidade (grupo P=65; C=141; OR=3,04), hipotireoidismo (grupo P=205; C=194; OR=1,26), idosas (grupo P=143; C=184; OR=2,03), Sd. hipertensivas (grupo P=213; C=338; OR=2,48), FCF não tranquilizadora (grupo P=11; C=65; OR=7,98), gemelaridade (grupo P=32; C=76; OR=3,2), prematuridade extrema (grupo P=55; C=92; OR=2,23). Quanto às distocias, 100% dos casos (50) evoluíram para cesariana. Não se mostraram como fatores de risco para cesarianas as variáveis: ITU (grupo P=68; C=26; OR=0,48) e adolescentes (grupo P=143; C=42; OR=0,35). Conclusão: A incidência de cesarianas avaliada foi maior que a meta estabelecida pela Organização Mundial da Saúde. As variáveis iteratividade, diabetes, síndromes hipertensivas, obesidade, hipotireoidismo, idosas, gemelaridade, distocia, FCF não tranquilizadora e prematuridade extrema apresentaram-se como fatores de risco para a realização de cesariana

Purpose: To estimate the incidence of cesarean sections and vaginal deliveries in a reference hospital for high-risk pregnancy. Moreover, to evaluate which clinical conditions are involved in a higher risk of cesarean section. Methods: Data was obtained from records from the Obstetric Surgical Center of Evangelical University Hospital of Curitiba. Records contained totality of births from April 2013 to April 2014. Variables considered were: dystocia, electronic fetal heart monitoring, ultrasound gestational age, twin pregnancy, gestational diabetes mellitus, hypertensive syndromes (hypertensive disorders of pregnancy, pre-eclampsia and systemic arterial hypertension), multiple urinary tract infections, pregnant woman's age, iterative (≥ 2 cesarean sections), hypothyroidism and number of previous pregnancies, vaginal and/or cesarean deliveries. Variables occurrence was divided into two groups: P (vaginal deliveries) and C (cesarean sections). Statistical analyses included Student's t test, differences between frequencies were calculated by Chi-Square test and between mean values by non-parametric Mann­Whitney test. P values<0.05 were considered as significant. Results: From the total of 2617 births, the number of natural childbirths corresponded to a rate of 56.2%, while 43.8% were cesarean sections. Cesarean delivery's rate was statistically significant, thus considered a risk factor for its performance in the variables: iterative (group P=2; C=234; OR=188,9), gestational diabetes mellitus (group P=183; C=230; OR=1,77), obesity (group P=65; C=141; OR=3,04), age >35 (group P=143; C=184; OR=2,03), Hypertensive Syndromes (group P=213; C=338; OR=2,48), twin pregnancy (group P=32; C=76; OR=3,2), extreme premature birth (group P=55; C=92; OR=2,23). When it comes to dystocia, 100% of the cases (50) resulted in cesarean delivery. Not considered to be risk factors for cesarean delivery are the variables: multiple urinary tract infections (group P=68; C=26; OR=0,48) and adolescence (group P=143; C=42; OR=0,35). Conclusion: The rate of cesarean sections performed in the service was higher than the target set by the World Health Organization. The variables iterative, gestational diabetes mellitus, hypertensive syndromes, age >35, hypothyroidism, obesity, twin pregnancy, dystocia, electronic fetal heart monitoring and extreme premature birth presented themselves as risk factors for cesarean section

Perfil clínico-epidemiológico e evolução de pacientes com fratura diafisária de tíbia atendidos no Hospital Universitário Evangélico de Curitiba - HUEC / Clinical epidemiological profile and evolution of patients with fracture of tibia served diaphyseal in University Hospital Evangelic of Curitiba - HUEC

Objetivo: Descrever um perfil clínico-epidemiológico de pacientes com fratura de diáfise da tíbia. Metodologia: Estudo longitudinal, retrospectivo e descritivo, através da avaliação de prontuários de 72 pacientes atendidos no Hospital Universitário Evangélico de Curitiba no período de março de 2014 a abril de 2015. O acompanhamento da evolução clínica foi feito até a última alta ambulatorial. Resultados: Houve predomínio do sexo masculino, com 64 pacientes (88,89%), em relação ao sexo feminino, com 8 pacientes (11,11%). As fraturas fechadas ocorreram em 48 pacientes (66,67%), enquanto que as fraturas expostas foram observadas em 24 pacientes (33,33%). A maior incidência foi na faixa etária entre 21 e 40 anos, representando 41,67% dos pacientes. As principais causas de fratura foram por acidentes de trânsito, com 40 casos (55,56%), seguida de quedas, com 16 casos (22,22%). O tempo médio de consolidação da fratura foi de 19,95 semanas. As complicações mais comuns foram: infecção (35,56%), retardo de consolidação (22,22%) e pseudoartrose (20%). O tempo médio de acompanhamento ambulatorial foi de 6,5 meses. Conclusão: Foi possível confirmar a importância dos estudos epidemiológicos para a melhor caracterização dos pacientes com fratura diafisária de tíbia, sendo úteis para aprimorar a conduta terapêutica

Objective: describe a clinical and epidemiological profile of patients with tibial shaft fracture. Methods: A longitudinal, retrospective and descriptive study through epidemiological evaluation of the records of 72 patients treated at Hospital Universitário Evangélico de Curitiba from March 2014 to April 2015. The monitoring of clinical progress was made until the medical release. Results: There was a predominance of males, with 64 patients (88.89%) compared to females, with 8 patients (11.11%). The closed fractures occurred in 48 patients (66.67 %), while the exposed fractures was observed in 24 patients (33.33 %). The highest incidence was in the age group between 21 and 40 years representing 41.67% of the patients. The main fracture causes were due to traffic accidents, with 40 cases (55,56%), followed by falls, with 18 cases (22,22%). The average time of fracture healing was 19.95 weeks. The most common complications: infection (35.56 %), delayed consolidation (22.22%) and pseudoarthrosis (20%). The average time of outpatient follow-up was 6.5 months. Conclusion: It was possible to confirm the importance of epidemiological studies to better characterization of the patients with diaphyseal fractures of the tibia, being useful to guide the best therapeutic approach

Distribuição das lesões de tireoide na classificação de Bethesda para punções aspirativas / Distribuition of thyroid lesions in the classification of Bethesda for aspiration punctures

OBJETIVO: Classificar os resultados de punções aspirativas prévias de tireoide de acordo com o sistema de Bethesda e verificar sua distribuição frente à nova classificação. MATERIAL E MÉTODOS: Foi realizado um estudo retrospectivo usando laudos citopatológicos de pacientes portadores de nódulos tireoidianos, cujas PAAF foram analisadas no Centro de Patologia de Curitiba ­ Hospital Nossa Senhora das Graças, Curitiba - PR, no período de janeiro 2009 a dezembro de 2010. A amostra analisada constitui-se de 1833 laudos. RESULTADOS: Foram recatalogados 1833 laudos citopatológicos de PAAF de 1476 pacientes, sendo 572 (31%) laudos do ano de 2009 e 1262 (69%) do ano de 2010. Baseado nos 1833 resultados de PAAF analisados, encontrou-se 14,73% de nódulos tireoidianos classificados como insatisfatório, 70,64% como benignos, 7,04% como atipias de significado indeterminado ou lesões foliculares de significado indeterminado, 2,13% como neoplasia folicular ou suspeito de neoplasia folicular, 1,2% suspeito para malignidade e 4,26% malignos. CONCLUSÃO: A reclassificação dos laudos citopatológicos de PAAF de tireoide para a nomenclatura de Bethesda esteve dentro de índices recomendados, auxiliando no monitoramento de boas práticas e controle de qualidade na emissão dos resultados de PAAF de tireoide

AIM: To classify the results of thyroid punctures previous aspiration according to the Bethesda system and verify their distribution across the new classification. MATERIALS AND METHODS : We conducted a retrospective study using cytological reports of patients with thyroid nodules whose FNA were analyzed in Curitiba Pathology Center - Hospital Nossa Senhora das Graças , Curitiba - PR, from January 2009 to December 2010. The sample consisted of 1833 reports . RESULTS: 1833 reports recataloged FNA of cytopathology of 1476 patients, 572 (31%) reports of 2009 and 1262 (69%) in the year 2010. Based on 1833 results of FNA analyzed, we found 14,73%% of thyroid nodules classified as Unsatisfactory, 70,64% as benign, 7,04% as atypia of undetermined significance or follicular lesions of undetermined significance, and 2,13% follicular neoplasm or suspicious for follicular neoplasm, suspicious for malignancy 1,2% and 4,26% malignant. CONCLUSION: The reclassification of cytopathology reports from thyroid FNA for the nomenclature of Bethesda was within recommended levels, assisting in the monitoring of good practices and quality control in issuing the results of thyroid FNA

Distribuição das lesões de tireóide na classificação de Bethesda para punções aspirativas / Distribuition of thyroid lesions in the classification of bethesda for aspiration punctures

OBJETIVO: Classificar os resultados de punções aspirativas prévias de tireóide de acordo com o sistema de Bethesda e verificar sua distribuição frente à nova classificação. MATERIAL E MÉTODOS: Foi realizado um estudo retrospectivo usando laudos citopatológicos de pacientes portadores de nódulos tireoidianos, cujas PAAF foram analisadas no Centro de Patologia de Curitiba ­ Hospital Nossa Senhora das Graças, Curitiba - PR, no período de janeiro 2009 a dezembro de 2010. A amostra analisada constitui-se de 1833 laudos. RESULTADOS: Foram recatalogados 1833 laudos citopatológicos de PAAF de 1476 pacientes, sendo 572 (31%) laudos do ano de 2009 e 1262 (69%) do ano de 2010. Baseado nos 1833 resultados de PAAF analisados, encontrou-se 14,73% de nódulos tireoidianos classificados como Insatisfatório, 70,64% como benignos, 7,04% como atipias de significado indeterminado ou lesões foliculares de significado indeterminado, 2,13% como neoplasia folicular ou suspeito de neoplasia folicular, 1,2% suspeito para malignidade e 4,26% malignos. CONCLUSÃO: A reclassificação dos laudos citopatológicos de PAAF de tireóide para a nomenclatura de Bethesda esteve dentro de índices recomendados, auxiliando no monitoramento de boas práticas e controle de qualidade na emissão dos resultados de PAAF de tireóide

AIM: To classify the results of thyroid punctures previous aspiration according to the Bethesda system and verify their distribution across the new classification. MATERIALS AND METHODS : We conducted a retrospective study using cytological reports of patients with thyroid nodules whose FNA were analyzed in Curitiba Pathology Center - Hospital Nossa Senhora das Graças , Curitiba - PR, from January 2009 to December 2010. The sample consisted of 1833 reports . RESULTS: 1833 reports recataloged FNA of cytopathology of 1476 patients, 572 (31%) reports of 2009 and 1262 (69%) in the year 2010. Based on 1833 results of FNA analyzed, we found 14,73%% of thyroid nodules classified as Unsatisfactory, 70,64% as benign, 7,04% as atypia of undetermined significance or follicular lesions of undetermined significance, and 2,13% follicular neoplasm or suspicious for follicular neoplasm, suspicious for malignancy 1,2% and 4,26% malignant. CONCLUSION: The reclassification of cytopathology reports from thyroid FNA for the nomenclature of Bethesda was within recommended levels, assisting in the monitoring of good practices and quality control in issuing the results of thyroid FNA

Lúpus eritematoso sistêmico e Anti-Sm / Systemic lupus erythematosus and Anti-sm

Objetivos: Verificar a prevalência de anticorpo anti-Sm na população local com LES e correlacionar sua presença com o perfil clínico e sorológico da doença. Método: Foi realizada uma análise retrospectiva de 350 prontuários dos pacientes com LES. Como critério de inclusão o paciente deveria preencher os critérios classificatórios do ACR e ter a pesquisa do anti-Sm. Foram coletados dados acerca do perfil demográfico, clínico e sorológicos. Resultados: Existia presença do anti-Sm em 22,65%, dos pacientes. Encontrou-se associação significativa do anti-Sm com o anti-RNP. Conclusão: A prevalência do anticorpo anti-Sm foi de 22,65%. Ao correlacionarmos o perfil clínico e sorológico com a presença do anticorpo Anti-Sm, não foi encontrado correlação clínica significativa, havendo apenas relação deste anticorpo com o Anti-RNP

Objectives: To assess the prevalence of anti-Sm in local population with SLE and to determinate its correlation with serological and clinical disease. Metodology: We performed a retrospective analysis of 350 SLE patient's charts. As inclusion criteria the patient should have four of the eleven classification criteria of the ACR and the presence of the test for anti-Sm. We collected demographic, clinical and serological data. Results: Anti-Sm was found in 22.65% of the patients. We found significantly correlation between anti-Sm and anti-RNP. Conclusion: The prevalence of anti-Sm antibodies was 22.65%.No clinical important association was found with this autoantibody except by anti-RNP

Perfil clínico-epidemiológico e evolução de pacientes com fratura diafisária de tíbia atendidos no Hospital Universitário Evangélico de Curitiba - HUEC / Clinical epidemiological profile and evolution of patients with fracture of tibia served diaphyseal in University Hospital Evangelic of Curitiba - HUEC

Objetivo: Descrever um perfil clínico-epidemiológico de pacientes com fratura de diáfise da tíbia. Metodologia: Estudo longitudinal, retrospectivo e descritivo, através da avaliação de prontuários de 72 pacientes atendidos no Hospital Universitário Evangélico de Curitiba no período de março de 2014 a abril de 2015. O acompanhamento da evolução clínica foi feito até a última alta ambulatorial. Resultados: Houve predomínio do sexo masculino, com 64 pacientes (88,89%), em relação ao sexo feminino, com 8 pacientes (11,11%). As fraturas fechadas ocorreram em 48 pacientes (66,67%), enquanto que as fraturas expostas foram observadas em 24 pacientes (33,33%). A maior incidência foi na faixa etária entre 21 e 40 anos, representando 41,67% dos pacientes. As principais causas de fratura foram por acidentes de trânsito, com 40 casos (55,56%), seguida de quedas, com 16 casos (22,22%). O tempo médio de consolidação da fratura foi de 19,95 semanas. As complicações mais comuns foram: infecção (35,56%), retardo de consolidação (22,22%) e pseudoartrose (20%). O tempo médio de acompanhamento ambulatorial foi de 6,5 meses. Conclusão: Foi possível confirmar a importância dos estudos epidemiológicos para a melhor caracterização dos pacientes com fratura diafisária de tíbia, sendo úteis para aprimorar a conduta terapêutica

Objective: describe a clinical and epidemiological profile of patients with tibial shaft fracture. Methods: A longitudinal, retrospective and descriptive study through epidemiological evaluation of the records of 72 patients treated at Hospital Universitário Evangélico de Curitiba from March 2014 to April 2015. The monitoring of clinical progress was made until the medical release. Results: There was a predominance of males, with 64 patients (88.89%) compared to females, with 8 patients (11.11%). The closed fractures occurred in 48 patients (66.67 %), while the exposed fractures was observed in 24 patients (33.33 %). The highest incidence was in the age group between 21 and 40 years representing 41.67% of the patients. The main fracture causes were due to traffic accidents, with 40 cases (55,56%), followed by falls, with 18 cases (22,22%). The average time of fracture healing was 19.95 weeks. The most common complications: infection (35.56 %), delayed consolidation (22.22%) and pseudoarthrosis (20%). The average time of outpatient follow-up was 6.5 months. Conclusion: It was possible to confirm the importance of epidemiological studies to better characterization of the patients with diaphyseal fractures of the tibia, being useful to guide the best therapeutic approach

Análise dos casos de near miss materno no Hospital Universitário Evangélico de Curitiba / Analysis of the cases of near miss materno in the Evangelical University Hospital of Curitiba

Objetivo: Investigação dos casos de near miss materno em mulheres no ciclo grávido-puerperal internadas no serviço de Ginecologia e Obstetrícia do Hospital Universitário Evangélico de Curitiba - HUEC, identificando o(s) critério(s) em que cada gestante se enquadra dentro dos definidos de near miss materno pela Secretaria Municipal de Saúde de Curitiba, além de quantificar de acordo com faixa etária, realização e local do pré-natal. Metodologia: Estudo transversal observacional retrospectivo e prospectivo entre 10 de julho de 2014 até 10 de dezembro de 2014, com coleta de dados a partir do registro de internações do HUEC e identificação dos casos a partir do caderno de registro de atendimentos, sem contato direto com as pacientes. Identificação das hospitalizações maiores que sete dias através do relatório de internamentos do Setor de Obstetrícia do HUEC. Dados de pré-natal coletados no Sistema E-Saúde/Curitiba. Classificação como pré-natal completo aqueles com oito ou mais consultas e incompleto aqueles que tiveram entre um e sete atendimentos. Foram incluídas mulheres durante a gestação, parto ou nos primeiros 42 dias de puerpério que apresentaram quadro compatível de near miss com base nos critérios da Secretaria Municipal de Saúde de Curitiba. Resultados: Entre as 1450 internações analisadas, 200 se encaixaram em pelo menos um dos critérios adotados, sendo uma eliminada por resultar em óbito, totalizando 199 pacientes incluídas no trabalho. Foram identificados 26 critérios, sendo que algumas gestantes se enquadraram em apenas um e outras em até seis critérios. O mais prevalente foi a pré-eclâmpsia, estando presente em 111 pacientes, seguido pelo uso de sulfato de magnésio e internamento prolongado (37 pacientes cada). Na faixa etária de 18 a 35 anos se apresentam a maioria das pacientes (77%). No que se diz respeito ao pré-natal, aproximadamente 78% não o realizaram ou realizaram de forma incompleta. A média de consultas de pré-natal por gestante foi de 4,55. Na avaliação da frequência de critérios houve diferença significativa entre os diferentes grupos de pré- -natal. Conclusão: O estudo da morbidade materna grave/near miss no HUEC pode contribuir para destacar a relevância desse evento, além de identificar as características e condições clínicas mais constantes, notando- -se expressiva importância da realização de um pré-natal adequado em gestantes classificadas como de risco gestacional. Ademais, é notável por possibilitar ações preventivas direcionadas, assim como diminuir as taxas de mortalidade materna

Objective: Investigation of maternal near miss occurrence in women during their pregnancy-puerperal cycle, admitted in the Gynecology and Obstetrics service at the Evangelical University Hospital of Curitiba - EUHC, by identifying the criterion (a) in which each woman fits within the defined as maternal near miss by the Municipal Health Department of Curitiba, in addition to quantifying according to age group, realization and location of prenatal care. Methodology: Retrospective and prospective observational cross-sectional study between July 10, 2014 until December 10, 2014. Data was collected from the record of hospitalizations of EUHC and identificated the cases from the attendance record books, without direct contact with patients. Identification of hospitalization longer than seven days through the report of hospitalizations in the Obstetrics Sector of EUHC. Prenatal data was collected from the E-Health System/Curitiba. Complete pre-natal routine was considered in the patients with eight or more queries and incomplete in those who has between one and seven attendances. Were included women during pregnancy, childbirth or in the first 42 days postpartum who presented symptoms compatible with near miss, based on the criteria of the Municipal Health Department of Curitiba. Results: Among the 1450 hospitalizations analyzed, 200 are embedded in at least one of the criteria adopted, with one being eliminated for resulting in death, totalizing 199 patients included in the study. 26 criteria were identified, being that some pregnant women fit in only one and another in up to six criteria. The most prevalent was preeclampsia, being present in 111 patients, followed by the use of Magnesium Sulfate and prolonged internment (37 patients each). Most of the patients were in the age group of 18-35 years (77%). Concerning the prenatal, approximately 78% did not perform it or performed it incompletely. The average number of prenatal attendance by pregnant woman was 4.55. When compared the frequency of criteria, there was significant difference between the different prenatal groups. Conclusion: the study of severe maternal morbidity / near miss in EUHC can contribute to the knowledge of the importance of this event, in addition to identifying the features and more constant medical conditions, noting significant. importance of conducting adequate prenatal care in pregnant women classified as gestational risk. Moreover, it is notable for enabling targeted preventive actions, as well as for reducing maternal mortality rates

Avaliação do índice de cesarianas e partos normais em hospital de referência em gravidez de alto risco de Curitiba / Cesarean sections and vaginal deliveries index assessment in a reference hospital for high risk pregnancy in Curitiba

Objetivos: Avaliar a incidência de cesarianas e partos normais em um hospital de referência em alto risco gestacional. Além disso, avaliar as condições clínicas que implicam em um maior risco de realização de cesarianas. Métodos: Foram avaliados dados dos registros do Centro Cirúrgico Obstétrico do Hospital Universitário Evangélico de Curitiba, nos quais consta a totalidade de nascimentos no período de abril de 2013 a abril de 2014. Foram consideradas as seguintes variáveis nos grupos P (parto normal) e C (cesarianas): distocia, frequência cardíaca fetal (FCF) não tranquilizadora, idade gestacional ecográfica, gemelaridade, diabetes mellitus gestacional, síndromes hipertensivas (doença hipertensiva específica da gravidez, pré-eclâmpsia e hipertensão arterial sistêmica), infecção de trato urinário de repetição, idade da gestante, iteratividade, hipotireoidismo, número de gestações, partos e cesarianas prévias. A análise estatística foi realizada através dos testes t de Student, não-paramétrico de Mann-Whitney para variáveis quantitativas e do teste Qui-Quadrado para variáveis qualitativas. Valores de p < 0,05 indicaram significância estatística. Resultados: Do total de 2617 nascimentos no período o número de partos normais correspondeu a 1471, representando 56,2% e o de cesarianas 1146, representando 43,8%. As taxas de cesarianas mostraram-se significativas, configurandose como fator de risco para sua realização nas variáveis: iteratividade (grupo P=2; C=234; OR=188,9), DMG (grupo P=183; C=230; OR=1,77), obesidade (grupo P=65; C=141; OR=3,04), hipotireoidismo (grupo P=205; C=194; OR=1,26), idosas (grupo P=143; C=184; OR=2,03), Sd. Hipertensivas (grupo P=213; C=338; OR=2,48), FCF não tranquilizadora (grupo P=11; C=65; OR=7,98), gemelaridade (grupo P=32; C=76; OR=3,2), prematuridade extrema (grupo P=55; C=92; OR=2,23). Quanto às distocias, 100% dos casos (50) evoluíram para cesariana. Não se mostraram como fatores de risco para cesarianas as variáveis: ITU (grupo P=68; C=26; OR=0,48) e adolescentes (grupo P=143; C=42; OR=0,35). Conclusão: A incidência de cesarianas avaliada foi maior que a meta estabelecida pela Organização Mundial da Saúde. As variáveis iteratividade, diabetes, síndromes hipertensivas, obesidade, hipotireoidismo, idosas, gemelaridade, distocia, FCF não tranquilizadora e prematuridade extrema apresentaram-se como fatores de risco para a realização de cesariana

Purpose: To estimate the incidence of cesarean sections and vaginal deliveries in a reference hospital for high-risk pregnancy. Moreover, to evaluate which clinical conditions are involved in a higher risk of cesarean section. Methods: Data was obtained from records from the Obstetric Surgical Center of Evangelical University Hospital of Curitiba. Records contained totality of births from April 2013 to April 2014. Variables considered were: dystocia, electronic fetal heart monitoring, ultrasound gestational age, twin pregnancy, gestational diabetes mellitus, hypertensive syndromes (hypertensive disorders of pregnancy, pre-eclampsia and systemic arterial hypertension),multiple urinary tract infections, pregnant woman's age, iterative (≥ 2 cesarean sections), hypothyroidism and number of previous pregnancies, vaginal and/or cesarean deliveries. Variables occurrence was divided into two groups: P (vaginal deliveries) and C (cesarean sections). Statistical analyses included Student's t test, differences between frequencies were calculated by Chi-Square test and between mean values by non-parametric Mann­Whitney test. P values<0.05 were considered as significant. Results: From the total of 2617 births, the number of natural childbirths corresponded to a rate of 56.2%, while 43.8% were cesarean sections. Cesarean delivery's rate was statistically significant, thus considered a risk factor for its performance in the variables: iterative (group P=2; C=234; OR=188,9), gestational diabetes mellitus (group P=183; C=230; OR=1,77), obesity (group P=65; C=141; OR=3,04), age >35 (group P=143; C=184; OR=2,03), Hypertensive Syndromes (group P=213; C=338; OR=2,48), twin pregnancy (group P=32; C=76; OR=3,2), extreme premature birth (group P=55; C=92; OR=2,23). When it comes to dystocia, 100% of the cases (50) resulted in cesarean delivery. Not considered to be risk factors for cesarean delivery are the variables: multiple urinary tract infections (group P=68; C=26; OR=0,48) and adolescence (group P=143; C=42; OR=0,35). Conclusion: The rate of cesarean sections performed in the service was higher than the target set by the World Health Organization. The variables iterative, gestational diabetes mellitus, hypertensive syndromes, age >35, hypothyroidism, obesity, twin pregnancy, dystocia, electronic fetal heart monitoring and extreme premature birth presented themselves as risk factors for cesarean section

Análise experimental da influência de dietas ocidental e mediterrânea na distribuição de tecido adiposo / Experimental analysis of the influence of western and mediterranean diets in adipose tissue distribution

O objetivo desse estudo foi comparar efeitos de dietas balanceadas e hiperlipídicas e avaliar a ação do azeite de oliva extra virgem (AO) na distribuição e na quantidade de gordura corporal. 27 ratos machos Wistar, por 90 dias, foram divididos em grupos submetidos a alimentações balanceadas e hiperlipídica, associadas ou não ao AO. Dados antropométricos, tecido adiposo branco (TAB) e tecido adiposo marrom (TAM) foram coletados e analisados estatisticamente. Os resultados mostraram que o consumo de dieta hiperlipídica provocou alterações significativas no peso corporal e no peso do TAB. A administração contínua de dieta balanceada com AO mostrou-se com um potencial efeito benéfico no combate à obesidade e à deposição de gordura branca no organismo, não demostrando alterações significativas no TAM.

The aim of this study was to compare effects of balanced diet and hyperlipidemic diet and evaluate the effects of extra virgin olive oil (EV) in the distribution and amount of body fat. 27 male Wistar rats during 90 days were divided into groups fed balanced diet and hyperlipidemic diet, associated or not with AO. Anthropometric data, white adipose tissue (WAT) and brown adipose tissue (BAT) were collected and analyzed statistically. The results showed that consumption of fat diet has caused significant changes in body weight and TAB weight. Continuous administration of balanced diet with EV showed up with a potential beneficial effect in combating obesity and deposition of white fat in the body, without demonstrating significant changes in TAM.

Ausência de correlação entre ocorrência de anticorpos anticardiolipina e lesão valvular detectada à ecocardiografia transtoracica na população lúpica de Curitiba / Lack of correlation between antibody occurrence anticardiolipin injury valvular detected the transthoracic echocardiography in lupus population Curitiba

Objetivo: Verificar a associação entre ocorrência de anticorpos antifosfolipídeos e lesões valvulares detectadas pela ecocardiografia em portadores de LES. Material e Métodos: Foram analisados 93 pacientes com pelo menos 4 critérios diagnóstico do American College of Rheumatology de LES para achados ecocardiográficos e presença de anticorpos anticardiolipinas (ACA) IgG e IgM e de lupus anticoagulante (LAC). Os dados foram estudados por tabelas de frequência e contingência com testes de Fisher e do qui quadrado. Significância adotada de 5%. Resultados: 15,05% dos pacientes eram positivos para ACA IgG; 12,9 % eram positivos para ACA IgM e 20% eram positivos para LAC. Em cerca de 6% dos pacientes existiam os 3 anticorpos. Encontrou-se lesão valvular em 22,5%. Não se encontrou correlação entre lesão valvular e ocorrência de ACA Ig G (p=0,202); ACA IgM (p=0,458) ou LAC (p=0,686). Conclusão: Em nossa população lúpica não se encontrou associação entre a presença de anticorpos antifosfolípides e a lesão cardíaca valvular.

Objective: To verify if there is association between antiphospholipid antibodies and the presence of cardiac valvular lesions seen by echocardiography in lupus patients. Methods: We studied 93 patients with at least 4 American College of Rheumatology criteria for lupus with echocardiography and presence of anticardiolipin antibodies (ACA- Ig G and Ig M) and lupus anticoagulant (LAC). The data were studied by frequency and contingency tables with Fisher and chi square tests. Significance adopted was of 5%. Results: 15,05% of patients had ACA IgG, 12,9% had ACA IgM and 20% had LAC. In 6% of patients we found the 3 antibodies. 22,5% of patients had valvular lesions. We did not find a correlation of cardiac valvular lesion and ACA Ig G (p=0,202); ACA IgM (p=0,458) or LAC (p=0,686). Conclusion: There is no association between antiphospholipid antibodies and cardiac valvular lesions in our lupus population.

Disfunção tireoidiana em artrite reumatóide / Thyroid dysfunction in rheumatoid arthritis

OBJETIVO: Estudar a prevalência do hipotireoidismo em pacientes com artrite reumatóide (AR) e sua influência no decurso desta patologia reumatológica. MÉTODO: Foram revisados os prontuários de 123 pacientes de AR para idade, sexo, tempo de diagnóstico, fator reumatóide (FR), fator antinuclear (FAN), Síndrome de Sjögren secundária, nódulos reumatóides, alterações oculares (esclerite/afinamento corneano), índice funcional, HAQ (health assesment questionnaire) e função tireoidiana. RESULTADOS: Dos 123 pacientes, 109 eram mulheres e 14 homens, com média de idade de 43,4±13,5 anos e tempo de diagnóstico entre 6 e 447 meses. Destes 99 (80,4%) tinham função tireoidiana normal, 21 (17,07%) hipotireoidismo e 3 (2,43%) hipertireoidismo. Nos pacientes com AR e hipotireoideos, 76,1% e 21,5% tinham FR e FAN positivos respectivamente; nos pacientes sem alteração da função tireoidiana, 71,7% eram FR positivo e 21,2 % eram FAN positivos. Não houve diferença significativa entre os dois grupos, quando comparados quanto à frequência de Sjögren secundário, nódulos reumatóides, alterações oculares, HAQ, índice funcional. CONCLUSÃO: A prevalência de disfunção da tireóide em AR foi de 19,5% sendo bem mais comum o hipotireoidismo O aparecimento da disfunção tireoidiana não influiu em nenhuma das características clínicas ou sorológicas da AR.

OBJECTIVE: To study the prevalence of hypothyroidism in rheumatoid arthritis patients (RA) and its influence in the course of this rheumatic disease. Methods: We studied 123 rheumatoid arthritis patients' charts for age, disease duration, rheumatoid factor (RF), antinuclear antibodies (ANA), secondary Sjögren's syndrome, rheumatoid nodules, eye involvement (scleritis and corneal melting), functional index and HAQ (health assesment questionnaire), and thyroid function. RESULTS: Of these 123 patients 109 were women and 14 were men with mean age of 43,4 ± 13,5 and disease duration from 6 to 447 months. In this population, 99 (80,45% had normal thyroid function, 21 (17,07%) had hypothyroidism and 3 (2,43%) had hyperthyroidism. In the patients with RA and hypothyroidism, 76,1% and 21,5% had positive RF and ANA; in patients without thyroid dysfunction, 71,7% and 21,2% were RF and ANA positive. We could not find significant differences in the frequency of secondary Sjögren, rheumatoid nodules, eye involvement, HAQ or functional index. CONCLUSIONS: The prevalence of thyroid dysfunction in RA patients was of 19, 5% with hypothyroidism being the most common finding. Thyroid dysfunction didn't change clinical or serological characteristics of RA.

Gigantomastia gestacional: como abordar essa situação clínica / Gestational gigantomastia: how to address this clinical situation

A gigantomastia gestacional é uma desordem rara, na qual ocorre o crescimento excessivo e rápido das mamas, culminando com edema e congestão venosa das mesmas, além de ocasionar dor, ulceração da pele e infecção local. Estas complicações, em alguns casos, levam à necessidade de mastectomia de emergência ou abortamento induzido. A hipótese etiológica mais aceita é a de que exista uma estimulação anormal do tecido mamário, que pode ser desencadeada por níveis excessivos de hormônios ou por uma hipersensibilidade deste tecido a níveis hormonais normais. Apesar de a mama regredir após a gestação, raramente volta ao estado original; portanto, a redução da mama através de mastectomia ou mamoplastia geralmente é necessária. Além disso, é grande o risco de recorrências em gestações futuras. Os autores relatam o caso de gigantomastia em uma primigesta, com necessidade de interrupção da gravidez, devido ao risco de morte materna, e posterior intervenção cirúrgica com mamoplastia redutora.

Gestational gigantomastia is a rare disorder characterized by an excessive and rapid enlargement of the breasts, resulting in edema and venous congestion of breast tissue. It is a painful condition that causes skin ulceration and local infection. In some cases, these complications lead to an emergency mastectomy or induced abortion. The most probable etiology is an abnormal stimulation of breast tissue that is probably triggered by an abnormally elevated level of hormones or by the hypersensitivity of breast tissue to normal hormone levels. Although the breast volume decreases after pregnancy, it rarely returns to its original state; therefore, breast reduction through mastectomy or mammaplasty is usually necessary. Moreover, there is a high likelihood of recurrence in subsequent pregnancies. The authors report a case of gigantomastia in a primigravida that required pregnancy termination, because of the risk of maternal death, and a subsequent breast reduction surgery.

Prospective study evaluating oncological safety of axillary reverse mapping.

BACKGROUND: Axillary reverse mapping (ARM) is a new technique developed with the aim of reducing lymphedema rates by preserving lymphatic drainage of the upper limbs during sentinel lymph node biopsy and axillary lymph node dissection (ALND). However, it is unclear whether preservation of these lymph nodes affects oncological risk. The present study evaluated the presence of metastases in ARM nodes. METHODS: A total of 45 patients underwent ARM during ALND. Blue dye was used for ARM nodes localization. All axillary lymph nodes, including ARM nodes, were removed and sent separately for pathological evaluation of metastases. RESULTS: ARM identification was achieved in 40/45 patients (88.9 %). The average number of removed ARM nodes was 1.9. ARM nodes metastasis occurred in 10 of 40 patients (25 %). Patients with an axilla extensively affected by cancer had an elevated risk of metastasis to the arm's lymph nodes (p < 0.001). CONCLUSIONS: The rate of arm lymph nodes compromised by metastases calls into question the viability of the ARM technique. Larger studies may point to particular patient profiles for which ARM can be safely use.

Comparação de aspectos anatomopatológicos entre ROLL e carvão / Comparison of anatomopathological aspects between ROLL and Carbon localization

Objetivo: Vários métodos são descritos para a localização pré-operatória de lesões de mama clinicamente ocultas que necessitam de estudo histológico. A marcação com ROLL (localização radioguiada de lesões ocultas) utiliza injeção de radiofármaco na lesão oculta e localização intra-operatória com sonda de captação de radiação. A técnica de marcação com carvão consiste na injeção de solução de carvão ativado na lesão e localização visual. Ambas apresentam vantagens e desvantagens. O objetivo desse estudo foi comparar a eficácia entre as técnicas de carvão e ROLL para localização de lesões não palpáveis em relação aos aspectos anatomopatológicos, considerando as variáveis: peso e volume dos espécimes cirúrgicos excisados e alterações morfológicas quanto à resposta inflamatória. Método: Foram avaliados 84 casos mediante revisão retrospectiva de laudos anatomopatológicos e suas respectivas lâminas, 42 casos marcados com técnica ROLL e 42 com a técnica de carvão. As variáveis acima descritas foram comparadas por meio de testes estatísticos, assumindo nível de significância estatística de 5%. Resultados: Peso e volume dos espécimes cirúrgicos foram significativamente menores com a técnica do carvão (p=0,002 para peso e p<0,001 para volume). Quanto à reação inflamatória, observou-se presença de reação inflamatória aguda ou crônica na totalidade dos casos do grupo carvão, enquanto que em um caso do grupo ROLL foi demonstrada infiltração linfocítica (p<0,001). Conclusão: O carvãomostrou-se um marcador eficaz para localização de lesões não palpáveis da mama. Na comparação com a técnica do ROLL permitiu obtenção de espécimes cirúrgicos de menor peso e volume, estando associado à maior reação inflamatória.

Objective: Several methods are described for the preoperatively localization of clinically occult breast lesions that need to be defined histologically. The ROLL technique (radioguided occult lesion localization) uses radiotracer injection in hidden lesion and intraoperative localization with a gamma probe. The carbon marking is the injection of activated carbon in the lesion and visual localization. Both methods have advantages and disadvantages. The objective was to compare the efficacy of carbon marking and ROLL for locating non-palpable lesions by pathological aspects, considering the following variables: weight and volume of surgical specimens and morphological changes as the inflammatory response. Methods: 84 cases were assessed by a retrospective review of pathology reports and their histological H/E stained slides, 42 cases with ROLL and 42 with carbon marking. The variables described above were compared with Fisher exact test and Mann-Whitney test, assuming significance level of 5 %. Results: Weight and volume of surgical specimens were significantly lower with carbon marking (p=0.002 for weight and p<0.001 for volume). In relation of the inflammatory reaction, the presence of acute or chronic inflammatory reaction was observed in all cases of the carbon group, while in only one case of the ROLL group was demonstrated lymphocytic infiltration. Conclusion: The carbon marking is effective marker for locating nonpalpable breast lesions. In comparison with ROLL, allowed obtaining surgical specimens of lower weight and volume, but is associated with the presence of inflammatory reaction.