Avaliação dos dados contidos nas requisições do exame anatomopatológico da mama na cirurgia de troca ou explante de implantes mamários de silicone: análise de 251 casos / Evaluation of the data contained in the requests for the anatomopathological examination of the breast in the surgery of exchange or explantation of silicone breast implants: analysis of 251 cases

Introdução: A descrição do linfoma anaplásico de células T e o recente aumento das cirurgias de explante resultou na elevação do número de exames anatomopatológicos nas cirurgias de retirada de implantes mamários de silicone. O objetivo desta pesquisa é analisar a qualidade e quantidade de dados contidos na requisição do exame histopatológico. Métodos: Foram estudados 251 casos. Os seguintes dados foram analisados: sexo, idade, localização anatômica e espacial, lateralidade, história clínica, sinais e sintomas, quimioterapia e radioterapia prévia, hipótese diagnóstica, cirurgias prévias, tipo e marca do implante, exames de imagem prévios e número e características dos espécimes enviados. Resultados: A idade média foi de 43 anos. A lateralidade não foi mencionada em 16 (0,84%). A localização anatômica foi citada em 15 casos. O tipo de cirurgia foi mencionado por 40 (15,94%). O número de contêineres variou de 1 a 5, com mediana de 2. A cápsula foi enviada em 242 casos, em 161 de forma isolada, tecido mamário em conjunto com cápsula em 27, tecido mamário e cápsula em contêineres diferentes em 54 casos. A história clínica foi incluída em 19,12%, sinais e sintomas em 13,94%, em que a contratura foi o único termo inserido em 64. Em 27 requisições foi citado linfoma. Em 15 pacientes a presença de seroma foi referida e destes nove foram enviados. O tipo e marca do implante não foi citado. Conclusão: Os dados são escassos. Recomenda-se a criação de protocolos na retirada da cápsula e tecido adjacente, incluindo a orientação anatômica e espacial.

Introduction: The description of the Anaplastic Large Cell Lymphoma and the explantation surgery resulted in an increase of histopathological exams in breast implant removing surgery. Methods: 251 pathology requests were studied. The following data from the medical requests were analyzed: gender, age, type of surgery, number of specimens containers sent, laterality, anatomical and spatial location, clinical history, signs and symptoms, previous radiotherapy, previous chemotherapy, diagnostic hypothesis, previous surgeries, and reference to previous breast exams. Results: The mean age was 43 years old. Laterality was not mentioned in 16 requests. The surgery performed was mentioned in 15.94% requests. The number of containers varies from 1 to 5, with a median of 2. The containers include capsules in 242 cases, 161 as isolated capsule, 27 mammary tissue, and capsule in the same specimen, 54 mammary tissues sent in a separate container, anatomical and spatial location was mentioned in 6.33% cases. The detailed clinical data was included in 19.12%, signs and symptoms 13.94%, contracture as the only item mention in 64 of them. In 27 requests, lymphoma evaluation was requested. 15 included seroma and from nine of those, liquid was sent with a request for immunohistochemical and cytology analysis. None of the requests had any data on implant type or brand. Conclusion: The amount of information contained in the medical request forms is minimal. The authors recommend the need for a protocol to standardize the surgical removal of the capsule and the adjacent mammary tissue. Surgical specimens should be spatially oriented.

Pronunciamiento del Departamento de Medicina Legal y Ciencias Forenses sobre la práctica de exámenes corporales periciales sin consentimiento / Decision made by the Legal Medicine and Forensic Sciences Department on expert body examinations with no consent

Próximamente entrará en vigencia el nuevo Código del Proceso Penal uruguayo (Ley N° 19.293 y modificativas). Esta ley contempla la posibilitar de realizar exámenes corporales y toma de muestras biológicas a las personas imputadas de un delito sin su previo consentimiento. El Departamento de Medicina Legal y Ciencias Forenses. Facultad de Medicina. Universidad de la Republica advierte que esta disposición contraviene principios consagrados en la Convención Americana de Derechos Humanos, la Constitución de la República y el Código de Ética Médica (Ley N° 19.286). Asimismo, contradice los criterios establecidos en el Protocolo de Estambul de la Organización de Naciones Unidades y la Guía de principios éticos de la Red Iberoamericana de Instituciones de Medicina Legal y Ciencias Forenses, que funciona bajo los auspicios del Comité Internacional Cruz Roja. Por ello, en resguardo de los derechos humanos de los justiciables y la dignidad de la profesión médica al servicio de la justicia, el staff docente del Departamento de Medicina Legal y Ciencias Forenses. Esta postura cuenta con el apoyo de la Facultad de Medicina de la Universidad de la República y del colegio médico del Uruguay.

The new Uruguayan Code of Criminal Procedure (Act 19,293 and amendments) will soon come into force. This law provides for the possibility of performing body examinations of and taking biological samples from individuals who are accused of a crime without their prior consent. The Department of Legal Medicine and Forensic Sciences of the School of Medicine, University of the Republic hereby warns this legal provision contravenes principles enshrined in the American Convention on Human Rights, the Constitution and the Code of Medical Ethics (Act 19,286). Likewise, it contradicts the criteria established I the Istanbul Protocol of the United Nations and the Guide of ethical principles of the Ibero-American Network of Forensic Medicine and Forensic Sciences Institutions, sponsored by the International Committee of the Red Cross. Therefore, in safeguard of the human rights of those awaiting trial and the dignity of the medical profession at the service of justice, the faculty of the Department of Legal Medicine and Forensic Sciences of the University of the Republic exhorts other authorities to review the content of this norm. This stance is backed by the School of Medicine of the University of the Republic and the Uruguayan Medical College.

Proximamente entrará em vigor o novo Código do Processo Penal uruguaio (Lei N° 19.293 e modificações). Esta lei inclui a possibilidade de realizar exames corporais e coletar amostras biológicas a pessoas imputadas por um delito sem seu consentimento prévio. O Departamento de Medicina Legal y Ciencias Forenses da Facultad de Medicina da Universidad de la Republica adverte que esta disposição contraria princípios consagrados na Convenção Americana de Direitos Humanos, na Constituição da República e no Código de Ética Médica (Lei N° 19.286). Além disso contradisse os critérios estabelecidos no Protocolo de Istambul da Organização das Nações Unidas e na Guia de princípios éticos da Rede Ibero-americana de Instituições de Medicina Legal e Ciências Forenses, que funciona sob os auspícios do Comitê Internacional da Cruz Vermelha. Por isso, para preservar os direitos humanos dos justiciables e a dignidade da profissão médica a serviço da justiça, os docentes do Departamento de Medicina Legal y Ciencias Forenses. Esta posição conta com o apoio da Facultad de Medicina da Universidad de la República e do Colegio Médico del Uruguay.

Health workers cohort study: methods and study design / Cohorte de trabajadores de la salud: métodos y diseño del estudio

Abstract: Objective: To examine different health outcomes that are associated with specific lifestyle and genetic factors. Materials and methods: From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples. Results: A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese. Conclusion: Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.

Resumen: Objetivo: Examinar diferentes desenlaces en salud y su asociación con factores genéticos y del estilo de vida. Material y métodos: De marzo de 2004 a abril de 2006, una muestra de empleados de tres diferentes instituciones de salud y académicas, así como miembros de sus familias, fueron enrolados en el estudio, previa firma de consentimiento informado. Durante la medición basal y el seguimiento (2010-2013) los participantes completaron un cuestionario autoaplicado, exámenes físicos y proporcionaron muestras sanguíneas. Resultados: Fueron incluidos participantes (10 729) de entre 6 y 94 años en la medición basal. De estos, 70% fueron mujeres y 50% del Instituto Mexicano del Seguro Social. Aproximadamente 42% de los adultos tuvieron sobrepeso y 20% obesidad. Conclusión: Este estudio puede ofrecer conocimientos sobre los mecanismos de la enfermedad a través del análisis de factores de riesgo en una muestra de mexicanos.

Health workers cohort study: methods and study design.

OBJECTIVE:: To examine different health outcomes that are associated with specific lifestyle and genetic factors. MATERIALS AND METHODS:: From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples. RESULTS:: A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese. CONCLUSION:: Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.