Laparoscopic Retroperitoneal Lymph Node Dissection as a Safe Procedure for Postchemotherapy Residual Mass in Testicular Cancer.

BACKGROUND: To evaluate the feasibility, clinical and perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) in the management of patients with germ cell tumors (GCT) and residual post-chemotherapy mass. METHODS: We report our experience of 25 patients treated with L-RPLND between 2008 and 2015. All 25 patients were diagnosed with GCT by primary pathological evaluation of the specimens after orchiectomy. All patients received cisplatin-based chemotherapy. The technique consisted of L-RPLND excision of the residual mass using unilateral template dissection. We assessed perioperative data and histological findings. RESULTS: Surgery was successfully completed in 24 (96%) patients, 1 patient required an open surgery due to intense adhesions of the mass to the inferior vena cava. Mean operation time was 213 minutes. Mean blood loss was 260 mL. Postoperative complications were upper limb osteomuscular pain in 2 patients and chylous ascites in 1 patient. Mean postoperative hospital stay was 2 days. The median residual mass diameter was 3.3 cm (range 1.1-6.6 cm). Histopathological findings were necrotic tissue in 9 patients, teratoma in 9 patients, viable tumor in 6 patients, and Castleman disease in 1 patient. The median follow-up was 30 months. Normal antegrade ejaculation was preserved in all patients. CONCLUSIONS: Laparoscopic postchemotherapy RPLND is a feasible, safe, and highly oncologically efficient procedure, which has the benefits of minimally invasive surgery.

[Screening of infection by human immunodeficiency virus at the time of delivery]. / Rastreio da infecção pelo vírus da imunodeficiência humana no momento do parto.

PURPOSE: to evaluate the frequency of HIV tests performed during prenatal care and rapid tests ordered for pregnant women admitted at the time of delivery. METHOD: this was a cross-sectional study with 711 pregnant women at delivery during the period from January to July 2010. Women admitted for clinical control and those that did not allow their clinical data to be included in the study were excluded. The χ² test or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5%. RESULTS: the mean age of the patients was 25.77 ±6.7 years and the maximum and minimum age was 44 and 12 years, respectively. The average gestational age at the time of attendance was 38.41 ±6.7 weeks. Of these patients, 96.3% (n=685) had prenatal care and 11.1% (n=79) received prenatal care at our facility. The average number of prenatal care visits was 6.85 ±2.88, but 28.1% had less than six visits. We identified 10 HIV-positive pregnant women (1.4%) and two patients were known to be HIV positive. The others (n=8) were screened at birth and therefore did not receive ARV prophylaxis during the prenatal period. Three patients were admitted during the expulsion period and also did not receive intrapartum antibiotic prophylaxis. However, all newborns were evaluated, with lactation being suppressed and artificial milk being used. CONCLUSIONS: despite the measures established by the Ministry of Health, there are still flaws in the approach to these patients. Only with the participation of managers and professionals involved in care it will be possible to correct the direct actions that enable the effective prevention of vertical transmission of HIV.

Rastreio da infecção pelo vírus da imunodeficiência humana no momento do parto / Screening of infection by human immunodeficiency virus at the time of delivery

OBJETIVO: avaliar a frequência de testes anti-HIV realizados no pré-natal e de testes rápidos solicitados para estantes internadas para o parto. MÉTODO: trata-se de um estudo de corte transversal com 711 gestantes atendidas no momento do parto no período de janeiro a julho de 2010. Excluíram-se do estudo aquelas admitidas para controle clínico e as que não permitiram que seus dados fossem incluídos na pesquisa. Utilizou-se o teste do χ² ou o teste de Fisher para comparação de proporções na análise univariada. Foram incluídas no modelo de regressão logística todas as variáveis com valor p<0,25, chamado de modelo inicial. Utilizou-se o pacote estatístico SPSS e adotou-se o nível de significância estatística de 5 por cento. RESULTADOS: a idade média das pacientes foi de 25,77±6,7 anos, sendo a idade máxima e mínima de 44 e 12 anos, respectivamente. A média da idade gestacional no momento do atendimento foi de 38,41±6,7 semanas. Destas pacientes, 96,3 por cento (n=685) tinham acompanhamento pré-natal, sendo que 11,1 por cento (n=79) fizeram pré-natal na Maternidade Therezinha de Jesus, da Faculdade de Medicina da Universidade Federal de Juiz de Fora (UFJF), em Juiz de Fora, Minas Gerais. A média de consultas no pré-natal foi de 6,85±2,88, mas 28,1 por cento tiveram menos de 6 consultas. Identificaram-se 10 gestantes soropositivas para o HIV (1,4 por cento), sendo 2 pacientes sabidamente soropositivas. As demais (n=8) foram rastreadas no momento do parto e, por isso, não receberam a profilaxia ARV no pré-natal. Três pacientes foram admitidas em período expulsivo e também não receberam a profilaxia intraparto. Entretanto, todos os recém-nascidos foram avaliados e foi realizada a supressão da lactação e iniciada a formulação láctea...

PURPOSE: to evaluate the frequency of HIV tests performed during prenatal care and rapid tests ordered for pregnant women admitted at the time of delivery. METHOD: this was a cross-sectional study with 711 pregnant women at delivery during the period from January to July 2010. Women admitted for clinical control and those that did not allow their clinical data to be included in the study were excluded. The χ² test or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5 percent. RESULTS: the mean age of the patients was 25.77±6.7 years and the maximum and minimum age was 44 and 12 years, respectively. The average gestational age at the time of attendance was 38.41±6.7 weeks. Of these patients, 96.3 percent (n=685) had prenatal care and 11.1 percent (n=79) received prenatal care at our facility. The average number of prenatal care visits was 6.85±2.88, but 28.1 percent had less than six visits. We identified 10 HIV-positive pregnant women (1.4 percent) and two patients were known to be HIV positive. The others (n=8) were screened at birth and therefore did not receive ARV prophylaxis during the prenatal period. Three patients were admitted during the expulsion period and also did not receive intrapartum antibiotic prophylaxis. However, all newborns were evaluated, with lactation being suppressed and artificial milk being used...

Adenomastectomia bilateral com reconstrução imediata para tratamento de lesão benigna da mama / Bilateral adenomastectomy with immediate reconstruction for treatment of a benign breast lesion

Os fibroadenomas são atualmente considerados uma forma localizada de hiperplasia nodular do tecido do estroma e do componente glandular das mamas. Sua maior incidência é em pacientes jovens entre 20 e 30 anos. Geralmente, são lesões únicas, porém, em 10 a 15%, apresentam-se como lesões múltiplas, podendo ser bilaterais em 10% dos casos. A frequência de transformação maligna é muito baixa (0,1 a 0,3 % dos casos), ocorrendo em média 15 a 20 anos após a média de idade de ocorrência do fibroadenoma. Os autores relatam caso de paciente de 29 anos, solteira, técnica de enfermagem, natural de Belo Horizonte (MG) que procurou o consultório médico queixando-se de extremo desconforto e nodularidade em ambas as mamas. Ao exame apresentava incontáveis nódulos bilaterais, volumosos, móveis, de consistência fibroelástica e não aderidos a planos profundos, ocupando praticamente todo o volume de ambas as mamas. No entanto, apresentava ausência de linfonodos regionais palpáveis (ultrassonografia 1). Ao exame, constatou-se: Múltiplos nódulos bilaterais, limites precisos, dimensões variadas, sendo o maior medindo 8,0 cm no QSL mama E. Paciente submetida a tratamento cirúrgico com reconstrução.

Fibroadenomas are considered a localized form of nodular hyperplasia of breast stroma and glandular tissue. Its greater incidence is in the 20-30 year-old age range. Although lesions are generally solitary, in 10 to 15% of the cases there are multiple lesions, with bilaterality in 10%. Malignant transformation rates are very low (0.1 to 0.3 % of the cases), occurring on average 15 to 20 years after the mean age of fibroadenoma occurrence. The authors report the case of a 29-year-old single nursing technician from Belo Horizonte, Minas Gerais, Brazil, who consulted with bilateral breast discomfort and nodularity. Physical examination revealed a great number of large freely movable fibroelastic nodules, not adhered to deep planes, occupying the whole extension of both breasts. There were no palpable regional lymphnodes, though. An ultrasound scan showed multiple bilateral precisely outlined nodes, of varying sizes, the largest measuring 8.0 cm and situated in the upper lateral quadrant of the left breast. The patient underwent surgery with reconstruction.

Avaliação da efetividade dos cursos preparatórios para residência médica / Evaluation of the effectiveness of preparatory courses for medical residency admission tests

No Brasil, há um déficit de vagas para Residência Médica (RM) e maior concorrência em determinadasespecialidades ou regiões, propiciando o crescimento dos Cursos Preparatórios (CPs) para provas de RM. Os acadêmicos, cada vez mais, deixam atividades curriculares em segundo plano e se matriculam nesses cursinhos. Mediante um questionário dirigido aos candidatos do concurso de RM do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF), realizou-se um estudo para avaliara efetividade da preparação de alunos em CPs. A adesão foi de 74,7% dos 368 concorrentes, sendo que a maioria freqüentou CPs (72%). Não houve diferença significativa de aprovação entre os candidatos que se prepararam em CPs e os que não os freqüentaram. Já a média das notas dos candidatos que freqüentaram CPs foi 4,07 pontos maior (66,89 contra 62,82, p < 0,05). Conclui-se que, no modelo tradicional de avaliação, cuja prova teórica corresponde a 90% da nota final, a preparação dos alunos que freqüentaramCPs é mais eficaz, o que enaltece a memorização em detrimento de habilidades médicas. Nesse contexto, pode-se considerar o modelo 50/50, em que a prova prática corresponde a 50% da nota final, uma proposta adequada.

In Brazil there are not enough vacancies for Medical Residency (MR) and a very high competition for vacancies in certain specialties and regions. This favors the establishment of Preparatory Courses (PCs) for MR tests. Medical students have been increasingly neglecting their curricular activities for enrolling in these Preparatory Courses. For evaluating the effectiveness of these courses, a questionnaire was applied to the candidates for MR at the University Hospital of Federal University of Juiz de Fora. 74.7% from the 368 applicants agreed to participate in the study, most of which (72%) were frequentingPCs. There was no significant difference in the rate of approval among the candidates who had prepared themselves in PCs and those who did not. On the other hand, the average grade of the candidates that took PCs was 4.07 points higher (66.89 versus 62.82, p < 0.05). It is concluded that in the traditional evaluation model, whose theoretical test corresponds to 90% of the final grade, the preparation of thestudents who took PCs is more effective, valuing memorization above medical abilities. Thus, the 50/50 model, in which the practical test corresponds to 50% of the final grade, can be considered an adequate proposal.