Evaluation of the Influence of Geodimensional and Histological Parameters on the Need for Margin Widening in Breast Lesions Marked With Magnetic Seeds.

Objective: Breast cancer is an important topic worldwide, posing morbidity and mortality to women. Considerable efforts have been put in the early recognition of malignancy through different screening methods, such as mammography and ultrasound. The precise localization of infraclinical malignant lesions is key in surgical management and magnetic seeds gather particular interest for this purpose. As with other systems, a need for reintervention may be needed to obtain adequate surgical margins. This work evaluated the relation between the need for surgical reintervention in order to obtain negative margins and geodimensional and histological parameters. The main objective was the identification of parameters significantly associated with reintervention for margin widening. Materials and Methods: A retrospective analysis of 198 patients from a single centre was performed. The association between pre-defined geodimensional and histological parameters and the need for margin widening in infraclinical lesions marked with magnetic seed was evaluated. Results: Results showed that reintervention to widen margins was significantly higher in patients with ductal carcinoma in situ (DCIS) in the pre-operative biopsy when compared with invasive carcinoma (p = 0.03) in the bivariate analysis. No statistically significant differences were observed between the need for reintervention and lesion size (p = 0.197), breast quadrant location (p = 0.626) and distance of skin to lesion (p = 0.356). Conclusion: This work suggests that a more invasive margin clearance in lesions with a pre-operative DCIS diagnosis might obviate the need for reintervention to obtain negative margins. On the other hand, it is not necessary to be surgically more invasive in larger lesions, deeply located or that are present in a certain quadrant, since there are no significant differences regarding the need for reintervention.

Patient-Reported Outcomes and Experiences Assessment in Women with Breast Cancer: Portuguese Case Study.

In 2020, female breast cancer was the most commonly diagnosed cancer worldwide, representing the type of cancer with the highest incidence among women and the second most common cause of cancer death among women in all OECD countries. The conventional measures addressing the burden of breast cancer by measuring mortality, incidence, and survival do not entirely reflect the quality of life and patients experience when receiving breast cancer care. The main objective of this study is to capture patient-reported outcomes and experiences in women with breast cancer in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 378 women with breast cancer, with the age distribution being 19.8% aged 15 to 49 years and 80.2% aged 50 years and over. The data collection procedure and analysis followed the "OECD Breast Cancer Patient Reported Outcomes Working Group" protocol, allowing subsequent comparability with data from other OECD member countries. Most women were satisfied with the treatment outcome regarding the shape of their lumpectomy breast when wearing a bra (96.1%) and with the equal size of both breasts (78.3%). Findings on the WHO QOL-BREF showed that women manifest a lower score in well-being when compared with the general population or populations living with chronic diseases. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in breast cancer services in Portugal. Measuring PROMs and PREMs from Portuguese women receiving breast cancer care provides insightful evidence into the quality and value of cancer care.

The Role of the Immune System on the Cardiac Complications Observed in SARS-CoV-2

Abstract An acute respiratory syndrome caused by SARS-CoV2 was declared a pandemic by the World Health Organization. Current data in the world and in Brazil show that approximately 40% of patients who died have some type of cardiac comorbidity. There are also robust reports showing an increase in IL-6 / IL-1B / TNF-alpha and the presence of lymphopenia in patients with COVID-19. Our team and others have shown that increased cytokines are the link between arrhythmias/Left ventricular dysfunction and the immune system in different diseases. In addition, it has been well demonstrated that lymphopenia can not only be a good marker, but also a factor that causes heart failure. Thus, the present review focused on the role of the immune system upon the cardiac alterations observed in the SARS-CoV2 infection. Additionally, it was well described that SARS-CoV-2 is able to infect cardiac cells. Therefore, here it will be reviewed in deep.

Chloroquine inhibits pro-inflammatory effects of heme on macrophages and invivo.

BACKGROUND: Chloroquine has been used successfully to treat Malaria, including by chloroquine-resistant Plasmodium sp., indicating that it has effects on disease itself. Since heme has inflammatory effects and contributes to the pathogenesis of hemolytic diseases, we hypothesize that the anti-inflammatory effect of chloroquine is partially due to its inhibitory effect on heme-induced macrophage activation and on inflammatory tissue damage. METHODS: Bone marrow derived macrophages (BMDMs) were incubated with chloroquine before stimulation with heme, in different conditions, to evaluate cytokines secretion, ROS production, mitogen activated protein kinases (MAPK) or spleen tyrosine kinase (Syk) activation, alone or combined with LPS. The effects of chloroquine upon heme inflammation were also evaluated in vivo, through simultaneous i.p. injection of LPS and heme, intratracheal instillation of Poly-IC followed by heme injection, and in a rhabdomyolysis model. RESULTS: Chloroquine inhibited TNF secretion, mitochondrial ROS production, MAPK, and Syk activation induced by heme. Inhibition of TNF production could be mimicked by zinc ionophore quercetin, but not by primaquine, a chloroquine analog with low affinity for heme. IL-6 and IL-1ß secretions induced by heme in the presence of PRRs agonists were inhibited by chloroquine, but not by calcium chelator BAPTA or inhibitor of endosomal acidification concamycin B. Chloroquine also protected mice from heme inflammatory effects in vivo, inhibiting lethal synergism with PRR agonists, lung pathology caused by heme injection after intratracheal instillation of Poly-IC, and delaying death after rhabdomyolisis. CONCLUSION: Our data indicate that chloroquine might be used as a supportive therapy to control heme-induced deleterious inflammation in different hemolytic diseases.

Mitochondrial Reactive Oxygen Species Participate in Signaling Triggered by Heme in Macrophages and upon Hemolysis.

Hemolysis causes an increase of intravascular heme, oxidative damage, and inflammation in which macrophages play a critical role. In these cells, heme can act as a prototypical damage-associated molecular pattern, inducing TLR4-dependent cytokine production through the MyD88 pathway, independently of TRIF. Heme promotes reactive oxygen species (ROS) generation independently of TLR4. ROS and TNF production contribute to heme-induced necroptosis and inflammasome activation; however, the role of ROS in proinflammatory signaling and cytokine production remains unknown. In this study, we demonstrate that heme activates at least three signaling pathways that contribute to a robust MAPK phosphorylation and cytokine expression in mouse macrophages. Although heme did not induce a detectable Myddosome formation, the TLR4/MyD88 axis was important for phosphorylation of p38 and secretion of cytokines. ROS generation and spleen tyrosine kinase (Syk) activation induced by heme were critical for most proinflammatory signaling pathways, as the antioxidant N-acetyl-l-cysteine and a Syk inhibitor differentially blocked heme-induced ROS, MAPK phosphorylation, and cytokine production in macrophages. Early generated mitochondrial ROS induced by heme was Syk dependent, selectively promoted the phosphorylation of ERK1/2 without affecting JNK or p38, and contributed to CXCL1 and TNF production. Finally, lethality caused by sterile hemolysis in mice required TLR4, TNFR1, and mitochondrial ROS, supporting the rationale to target these pathways to mitigate tissue damage of hemolytic disorders.

Abdominal Actinomycosis misdiagnosed as liposarcoma

Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.

Abdominal Actinomycosis misdiagnosed as liposarcoma.

Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.

The Role of MIF on Eosinophil Biology and Eosinophilic Inflammation.

Macrophage migration inhibitory factor (MIF) is an inflammatory cytokine that participates in innate and adaptive immune responses. MIF contributes to the resistance against infection agents, but also to the cellular and tissue damage in infectious, autoimmune, and allergic diseases. In the past years, several studies demonstrated a critical role for MIF in the pathogenesis of type-2-mediated inflammation, including allergy and helminth infection. Atopic patients have increased MIF amounts in affected tissues, mainly produced by immune cells such as macrophages, Th2 cells, and eosinophils. Increased MIF mRNA and protein are found in activated Th2 cells, while eosinophils stock pre-formed MIF protein and secrete high amounts of MIF upon stimulation. In mouse models of allergic asthma, the lack of MIF causes an almost complete abrogation of the cardinal signs of the disease including mucus secretion, eosinophilic inflammation, and airway hyper-responsiveness. Additionally, blocking the expression of MIF in animal models leads to significant reduction of pathological signs of eosinophilic inflammation such as rhinitis, atopic dermatitis, eosinophilic esophagitis and helminth infection. A number of studies indicate that MIF is important in the effector phase of type-2 immune responses, while its contribution to Th2 differentiation and IgE production is not consensual. MIF has been found to intervene in different aspects of eosinophil physiology including differentiation, survival, activation, and migration. CD4+ T cells and eosinophils express CD74 and CXCR4, receptors able to signal upon MIF binding. Blockage of these receptors with neutralizing antibodies or small molecule antagonists also succeeds in reducing the signals of inflammation in experimental allergic models. Together, these studies demonstrate an important contribution of MIF on eosinophil biology and in the pathogenesis of allergic diseases and helminth infection.

Recomendaciones odontológicas en la pandemia COVID-19: revisión narrativa / Dental recommendations in the COVID-19 pandemic: a narrative review

INTRODUCCIÓN: La enfermedad por coronavirus-19 (COVID-19) es un problema mundial de salud pública debido a su morbimortalidad, especialmente en grupos de riesgo. El entorno odontológico tiene un alto riesgo de transmisión viral, por ello el objetivo de este estudio fue identificar recomendaciones para la atención odontológica durante esta pandemia. MÉTODOS: Se realizó una búsqueda de evidencia científica publicada desde 2002 hasta el 23 de marzo de 2020 en bases de datos electrónicas (MEDLINE/PubMed, EMBASE, Cochrane y Epistemonikos) y en las páginas electrónicas de la Asociación Dental Americana, de Centers for Disease Control and Prevention Oral Health, del Ministerio de Salud de Chile y de sociedades científicas. RESULTADOS: Se incluyeron nueve artículos publicados, en los cuales se recomienda el uso irrestricto de elementos de protección personal, preferir técnicas radiográficas extraorales, uso de enjuagues bucales con peróxido de hidrógeno al 1% o povidona yodada al 0,2%, técnica a cuatro manos con aspiración constante y uso de suturas reabsorbibles. Además, existe consenso respecto a que durante los periodos de transmisión comunitaria se deben posponer los tratamientos odontológicos no urgentes. CONCLUSIONES: Debido al alto riesgo de infección cruzada que presentan los equipos odontológicos, deben implementarse recomendaciones basadas en la mejor evidencia disponible, con el fin de preservar la salud de los miembros del equipo y de la población a su cuidado.

INTRODUCTION: COVID-19 is a world public health problem due to its morbidity and mortality, especially in at-risk groups. The dental environment has a high risk of viral transmission; accordingly, this study aimed to identify recommendations based on the best available evidence for dental care during this pandemic. METHODS: We performed a search for scientific evidence published since 2002 to March 23th 2020 in electronic databases (MEDLINE/PubMed, EMBASE, Cochrane, and Epistemonikos) and the web pages of the American Dental Association, Centers for Disease Control and Prevention Oral Health, the Ministry of Health in Chile and scientific societies. RESULTS: We included nine published studies. The recommendations were the following: unrestricted use of personal protection elements, use of extraoral radiographic techniques, use of mouth rinses with 1% hydrogen peroxide or 0.2% iodine povidone, a four-hand technique with ongoing aspiration and the use of absorbable sutures. Furthermore, there is a consensus that non-urgent treatments should be postponed during periods of community transmission. CONCLUSIONS: Dental practitioners are exposed to a high risk of cross-infection, meaning they must implement recommendations based on the best available evidence to preserve the health of team members and the population they are caring for.

The Paradoxical Leishmanicidal Effects of Superoxide Dismutase (SOD)-Mimetic Tempol in Leishmania braziliensis Infection in vitro.

Leishmaniasis is an infectious disease caused by protozoans of the genus Leishmania. The macrophage is the resident cell in which the parasite replicates and it is important to identify new compounds that can aid in parasite elimination since the drugs used to treat leishmaniasis are toxic and present side effects. We have previously shown that treatment of Leishmania braziliensis-infected macrophages with DETC (Diethyldithiocarbamate) induces parasite killing, in vivo. Thus, the objective of this study was to further evaluate the effect of oxidants and antioxidants in L. braziliensis-infected macrophages, following treatment with either oxidizing Hydrogen Peroxide, Menadione, DETC, or antioxidant [NAC (N-Acetyl-Cyteine), Apocynin, and Tempol] compounds. We determined the percentage of infected macrophages and number of amastigotes. Promastigote survival was also evaluated. Both DETC (SOD-inhibitor) and Tempol (SOD-mimetic) decreased the percentage of infected cells and parasite load. Hydrogen peroxide did not interfere with parasite burden, while superoxide-generator Menadione had a reducing effect. On the other hand, NAC (GSH-replenisher) and Apocynin (NADPH-oxidase inhibitor) increased parasite burden. Tempol surfaces as an interesting candidate for the chemotherapy of CL with an IC50 of 0.66 ± 0.08 mM and selectivity index of 151. While it remains obscure how a SOD-mimetic may induce leishmanicidal effects, we suggest the possibility of developing Tempol-based topical applications for the treatment of cutaneous leishmaniasis caused by L. braziliensis.

Toll-Like Receptor 4 and NLRP3 Caspase 1- Interleukin-1ß-Axis are Not Involved in Colon Ascendens Stent Peritonitis-Associated Heart Disease.

Hemodynamic collapse and myocardial dysfunction are among the major causes of death in severe sepsis. The purpose of this study was to assess the role played by toll-like receptor 4 and by the NLRP3 inflammasome in the cardiac dysfunction that occurs after high-grade polymicrobial sepsis. We performed the colon ascendens stent peritonitis (CASP) surgery in Tlr4, Nlrp3, and caspase-1 mice. We also assessed for the first time the electrical heart function in the colon ascendens stent peritonitis (CASP) model. The QJ interval was increased in wild-type C57BL/6J mice after CASP when compared with sham controls, a result paralleled by an increase in the cardiac action potential (AP) duration (APD). The decreases in ejection fraction (EF), left ventricle end diastolic volume, stroke volume, and cardiac output found after CASP were similar among all groups of mice. Similar heart response was found when Nlrp3 mice were submitted to high-grade cecal ligation and puncture. Despite developing cardiac dysfunction similar to wild types after CASP, Nlrp3 mice had reduced circulating levels of interleukin (IL)-1ß, IL-6 and tumor necrosis factor-α. Our results demonstrate that the genetic ablation of Tlr4, Nlrp3, and caspase-1 does not prevent the cardiac dysfunction, despite preventing the increase in pro-inflammatory cytokines, indicating that these are not feasible targets to therapy in high-grade sepsis.

Diálogos com adolescentes sobre direitos sexuais na escola pública: intervenções educativas emancipatórias! / Dialogues with adolescents on sexual rights in public school: emancipatory educational interventions / Diálogos con adolescentes sobre derechos sexuales en la escuela pública: intervenciones educativas emancipatorias!

Este estudo busca compreender significados e saberes de adolescentes sobre direitos sexuais para subsidiar intervenções educativas emancipatórias nas escolas. Desenvolveu-se pesquisa de abordagem qualitativa, foram realizadas entrevistas individuais com 29 adolescentes de 15 a 18 anos, alunos do ensino médio de escola pública e utilizou-se análise de conteúdo para interpretação das informações em profundidade. A pesquisa revelou que há falhas e omissões entre o que se estabelece nas leis e sua efetivação no cotidiano dos adolescentes, com violações aos seus direitos sexuais, tais como poucas informações qualificadas sobre sexualidade, a falta da educação em sexualidade nas escolas para todos os alunos, além de serviços de saúde específicos que atendam às suas necessidades, o que afeta a saúde sexual. Intervenções educativas emancipatórias que considerem conhecimentos científicos e os saberes de adolescentes e o pleno exercício da cidadania sexual podem reduzir vulnerabilidades relacionadas à saúde sexual e gerar transformações na realidade.

This study aims to understand the meanings and knowledge of adolescents about sexual rights to subsidize educational emancipatory interventions in schools. Qualitative approach research was developed, individual interviews were conducted with 29 adolescents aged 15 to 18, high school students from public schools, and content analysis was used to interpret the information in depth. The research revealed that there are flaws and omissions between what is established in the laws and their effectiveness in the daily life of adolescents, with violations of their sexual rights, such as few qualified information about sexuality, lack of sexuality education in schools for all students, besides Of specific health services that meet their needs, which affects sexual health. Emancipatory educational interventions that consider scientific knowledge and the knowledge of adolescents with the full exercise of sexual citizenship can reduce vulnerabilities related to sexual health and generate transformations in reality.

Este estudio busca comprender significados y saberes de adolescentes sobre derechos sexuales para subsidiar intervenciones educativas emancipatorias en las escuelas. Se desarrolló investigación de abordaje cualitativo, se realizaron entrevistas individuales con 29 adolescentes de 15 a 18 años, estudiantes de la Enseñanza Media de escuela pública, se utilizó análisis de contenido para interpretación de las informaciones en profundidad. La investigación reveló que hay fallas y omisiones entre lo que se establece en las leyes y su efectividad en el cotidiano de los adolescentes, con violaciones a sus derechos sexuales, tales como pocas informaciones calificadas sobre sexualidad, falta educación en sexualidad en las escuelas para todos los alumnos, además de servicios de salud específicos que atiendan a sus necesidades, lo que afecta la salud sexual. Las intervenciones educativas emancipatorias que consideren conocimientos científicos y los saberes de adolescentes con el pleno ejercicio de la ciudadanía sexual pueden reducir vulnerabilidades relacionadas con la salud sexual y generar transformaciones en la realidad.

ROS and Trypanosoma cruzi: Fuel to infection, poison to the heart.

The activation of macrophage respiratory burst in response to infection with Trypanosoma cruzi inflicts oxidative damage to the host's tissues. For decades, the role of reactive oxygen species (ROS) in the elimination of T. cruzi was taken for granted, but recent evidence suggests parasite growth is stimulated in oxidative environments. It is still a matter of debate whether indeed oxidative environments provide ideal conditions (e.g., iron availability in macrophages) for T. cruzi growth and whether indeed ROS signals directly to stimulate growth. Nitric oxide (NO) and ROS combine to form peroxynitrite, participating in the killing of phagocytosed parasites by activated macrophages. In response to infection, mitochondrial ROS are produced by cardiomyocytes. They contribute to oxidative damage that persists at the chronic stage of infection and is involved in functional impairment of the heart. In this review, we discuss how oxidative stress helps parasite growth during the acute stage and how it participates in the development of cardiomyopathy at the chronic stage.

Parathyroid carcinoma: From a case report to a review of the literature.

INTRODUCTION: Parathyroid carcinoma is a rare endocrine malignancy. The reported incidence is from 0.5 to 5% of primary hyperparathyroidism cases in various series. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. PRESENTATION OF CASE: We report a case of parathyroid carcinoma occurring in a 60-year-old woman who presented to our institution with persistent hyperparathyroidism and hypercalcemia 3 years after being submitted to one gland parathyroidectomy in another hospital. DISCUSSION AND CONCLUSION: A review of the related literature follows.

Direitos humanos, cidadania sexual e promoção de saúde: diálogos de saberes entre pesquisadores e adolescentes / Human rights, sexual citizenship and health promotion: dialogues of knowledge between researchers and adolescents

RESUMO Este artigo apresenta uma experiência de educação em saúde conduzida por pesquisadores e estudantes do Ensino Médio de uma escola pública de Belo Horizonte (MG). Demonstra como problematizar direitos humanos, saúde e cidadania sexual, contextualizada à realidade de adolescentes. Evidenciou-se que a precariedade da vida, iniquidades de gênero, silenciamentos, negação de direitos sexuais, informações qualificadas insuficientes afetam a saúde sexual de adolescentes. O diálogo de saberes entre pesquisadores e adolescentes sobre direitos sexuais interfere positivamente na promoção da saúde sexual. Este relato pode contribuir para o planejamento de atividades na atenção primária para a promoção de saúde.

ABSTRACT This article presents an experience of health education conducted by researchers and High School students of a public school in Belo Horizonte (MG). It demonstrates how to problematize human rights, health and sexual citizenship, contextualized to the reality of adolescents. It has been emphasized that precariousness of life, gender inequities, silencing, denial of sexual rights, insufficient qualified information affect the sexual health of adolescents. The dialogue of knowledge between researchers and adolescents about sexual rights interferes positively in the promotion of sexual health. This report may contribute to the planning of activities in primary attention, for health promotion.

Macrophage-dependent IL-1ß production induces cardiac arrhythmias in diabetic mice.

Diabetes mellitus (DM) encompasses a multitude of secondary disorders, including heart disease. One of the most frequent and potentially life threatening disorders of DM-induced heart disease is ventricular tachycardia (VT). Here we show that toll-like receptor 2 (TLR2) and NLRP3 inflammasome activation in cardiac macrophages mediate the production of IL-1ß in DM mice. IL-1ß causes prolongation of the action potential duration, induces a decrease in potassium current and an increase in calcium sparks in cardiomyocytes, which are changes that underlie arrhythmia propensity. IL-1ß-induced spontaneous contractile events are associated with CaMKII oxidation and phosphorylation. We further show that DM-induced arrhythmias can be successfully treated by inhibiting the IL-1ß axis with either IL-1 receptor antagonist or by inhibiting the NLRP3 inflammasome. Our results establish IL-1ß as an inflammatory connection between metabolic dysfunction and arrhythmias in DM.

Single Jejunum Metastasis from Breast Cancer Arising Twelve Years after the Initial Treatment.

Metastatic involvement of gastrointestinal tract from breast cancer is a rare event. We report the case of a 61-year-old woman presenting with bowel obstruction, related to metastasis of a primary breast cancer she had 12 years earlier (a triple-negative invasive ductal carcinoma treated with surgery and chemotherapy). Bowel obstruction was caused by a 20-centimeter tumor in the jejunum, involving also the transverse colon. The patient underwent en bloc resection of tumor with jejunum and transverse bowel segment and received adjuvant chemotherapy with carboplatin and paclitaxel. Twenty months later, she was alive without disease recurrence.

Inflammatory myofibroblastic tumor presenting as ileocecal intussusception-A case report.

INTRODUCTION: Inflammatory myofibroblastic tumor (IMFT) is an uncommon mesenchymal solid tumor commonly documented in children and young adults. It is usually located in lungs however, extrapulmonary involvement has also been reported. Here we report a case of IMFT presenting as an ileocecal intussusception. PRESENTATION OF CASE: A 55-year-old man presented with a two months history of colicky abdominal pain, more intense at the right inferior abdominal quadrant, and unintentional weight loss of 8kg in the previous four months. Computer tomography showed an image of intussusception at the cecum. Colonoscopy demonstrated a pediculated tubular lesion, with the base near ileocecal valve. We performed a right hemicolectomy. Histopathological examination of the tumor revealed an IMFT. DISCUSSION: IMFT usually affects lungs with rare gastrointestinal involvement. Clinical presentation is related with location of the neoplasm. Intussusception in adults presents with non-specific symptoms and classical image signs facilitate preoperative diagnosis. IMFT diagnosis is histopathological which usually implies surgical resection. Complete surgical excision, with microscopically clear margins, is the mainstain of treatment, with virtually no local recurrence or metastasis. CONCLUSION: Gastrointestinal IMFT are rare in the adult population and clinical features depend on its location. Surgical approach with total excision of the neoplasm confirms the diagnosis. Prognosis is good with the main prognostic indicator being the adequacy of the primary excision.

Uso da bandagem elástica associada ao tratamento fonoaudiológico no controle da sialorréia / Use of elastic bandage associated with speech therapy in the control ofsialorrhea (hypersalivation)

OBJETIVO: verificar a efetividade do uso da bandagem elástica associada ao tratamento fonoaudiológico no controle da sialorréia. MÉTODOS: estudo longitudinal realizado com onze crianças com quadro de sialorréia crônica e alteração neurológica. Foi verificada a percepção do fonoaudiólogo e do responsável acerca da gravidade e o número de toalhas/paninhos de boca utilizados ao dia. Empregou-se também a sialometria. Cada participante recebeu a aplicação da bandagem elástica Kinesio Tape na região da musculatura supra-hióidea por 30 dias. As crianças foram avaliadas sem a bandagem (T0), imediatamente após a retirada da bandagem (T1) e três meses após (T2). O tratamento fonoaudiológico foi realizado pelo o mesmo profissional em duas sessões semanais. Os dados foram analisados estatisticamente. RESULTADOS: no questionário verificou-se redução da queixa de engasgos com saliva em T1 (p=0,024).A média de uso diário de toalhas/paninhos era de quatro (10,2%) em T0, duas (5,1%) em T1 e quatro (10,2%) em T2.De acordo com a sialometria, verificou-se redução da sialorréia de T0 para T1 (p=0,018) e ausência de diferença entre T0 e T2 (p=0,215) e aumento de T1 para T2 (p=0,05).De acordo com a percepção do fonoaudiólogo houve redução da sialorréia 30 dias após o uso da bandagem, entretanto não se observou melhora ao se comparar os resultados 30 dias após o uso e três meses sem a bandagem. CONCLUSÃO: a bandagem elástica se mostrou eficaz no controle da sialorréia durante seu período de uso, não sendo observada permanência dos resultados após interrupção da aplicação. .

PURPOSE: to verify the effectiveness of the use of elastic bandage associated with speech therapy to control sialorrhea. METHODS: a longitudinal study was conducted with eleven children with a condition of chronic hypersalivation and neurological disorders. The perception of the speech therapists and of the responsible as of the graveness and the number of mouth towels utilized per day. Sialometry was also applied. Each participant received an application of the Kinesio Tape elastic bandage in the supra-hiodea musculature for thirty days. The children were evaluated without the bandage (T0), immediately after removal of the bandage (T1) and three months after (T2). The speech therapy treatment was realized by the same professional in two weekly sessions. The data was analyzed statistically. RESULTS: it was verified in the questionnaire there was a reduction of complaints of saliva choking in T1 (p=0.024). The average daily use of towels / cloths was of four (10.2%) in T0, two (5.1%) in T1 and four (10.2%) at T2. According to sialometry, there was a reduction of drooling from T0 to T1 (p=0.018) and no difference between T0 and T2 (p=0.215) and a raise from T1 to T2 (p=0.05). According to the speech therapist perception there was a reduction in drooling after thirty days after the use of the bandage, however no improvement was observed when comparing the results of thirty days without usage and three months without the bandage. CONCLUSION: the taping has shown to be effective in controlling sialorrhea during its use period, not being observed the permanence of the results after interruption of its application. .

Metástasis umbilical: nódulo de la Hermana María José / Umbilical metastasis: Sister Mary Joseph´s nodule

El término “nódulo de la hermana María José” se refiere a la presencia de una lesión umbilical, generalmente de larga evolución,que representa una metástasis cutánea relacionada habitualmente con una neoplasia intra abdominal. Las metástasis umbilicales se presentan por lo general tardíamente en el curso de neoplasias, coincidentes o secundarias a carcinomatosis peritoneal. Su presencia es índice de mal pronóstico ya que se relaciona con una baja sobrevida. Habitualmente, al momento del diagnóstico, los recursos terapéuticos son escasos. A continuación se presenta el caso de una paciente de sexo femenino, intervenida 4 años previos a la consulta por carcinoma de endometrio, que presenta una tumoración abdominal compatible con el diagnostico de Nódulo de la Hermana María José, resultando ser una metástasis cutánea de su neoplasia previa.

The term “Sister Mary Joseph ́s nodule” is related to the presence of a long development umbilical lesion, usually representing a cutaneous metastasis from an intraabdominal neoplasia. Umbilical metastases often are present lately in the course of neoplasias, coincident or secondary to peritoneal carcinomatosis, and are a poor prognosis indicator associated with low survival. Treatment resources are scarce at the time of diagnosis. We report a female patient, intervened four years ago because an endometrial carcinoma, with an abdominal tumor consistent with Sister Mary Joseph ́s nodule, turning out to be a cutaneous metastasis from her previous neoplasia.