Gestação ectópica em cicatriz de cesárea prévia, relato de caso / Cesarean scar pregnancy, case report

Gestação ectópica é a condição na qual ocorre implantação do embrião fora da cavidade uterina, sendo um dos locais mais raros as cicatrizes de histerotomia, objeto de estudo deste relato de caso. Paciente, 28 anos, procurou a emergência com queixa de dor em baixo ventre e sangramento vaginal discreto, beta-hCG positivo e ultrassonografia com diagnóstico de gestação ectópica com implantação na cicatriz da histerotomia prévia. Foi submetida a tratamento medicamentoso com metotrexate e acompanhada com dosagens seriadas de beta-hCG quantitativo. A terapêutica específica da gestação em cicatriz de cesárea prévia ainda não está bem estabelecida, portanto, segue o tratamento padrão das gestações ectópicas, o qual pode ser clínico ou cirúrgico dependendo das condições apresentadas pela paciente.

Ectopic pregnancy is a pregnancy outside the uterine cavity, one of the most uncommun place to occur is in a cesarean scar, which is the study object of this case report. Patient, 28, looked for help at emergency with complaint of pain in lower abdomen and discreet vaginal bleeding, positive beta-hCG and ultrasonography diagnosis of ectopic pregnancy implantated in the preview scar hysterotomy. She underwent a medicated treatment with methotrexate and monitored with serial measurements of quantitative beta-hCG. The specific therapy of cesarean scar pregnancy is not established yet, therefore, it follows the standard treatment of ectopic pregnancies, which can be clinical or surgical, depending on the patient's conditions.

Prevalência de sífilis em parturientes atendidas em uma maternidade na cidade de Criciúma, Santa Catarina / Prevalence of syphilis in parturients attended at a maternity in the city of Criciúma, Santa Catarina

A sífilis é doença sistêmica especialmente preocupante durante a gestação devido ao risco de transmissão fetal. Pode evoluir com óbito perinatal, parto prematuro, baixo peso ao nascer, anomalias congênitas e sequelas auditivas e neurológicas. Este estudo teve como objetivo principal conhecer a prevalência de sífilis em parturientes atendidas em uma maternidade na cidade de Criciúma, Santa Catarina, no período de janeiro de 2012 a dezembro de 2016. Trata-se de estudo transversal, realizado através da coleta de dados de prontuários médicos e fichas de notificação de sífilis em gestantes. Foram notificados 117 casos de sífilis, porém somente 69 preencheram os critérios de inclusão e compuseram a amostra final. A prevalência de sífilis foi de 0,61 casos a cada 100 parturientes, com notificação progressiva no período do estudo. A média de idade das pacientes foi 23,62 anos, maioria solteira (40,6%), multigesta (63,7%), cor branca (68,1%), com ensino fundamental completo ou ensino médio incompleto (40,6%) e do lar (52,2%). 73,2% realizaram seis ou mais consultas pré-natal, houve predomínio (69,2%) dos altos títulos de VDRL (≥1:8) no momento do diagnóstico e 75,3% das gestantes foram tratadas com Penicilina G benzatina. Por outro lado, apenas 30,4% dos parceiros recebeu tratamento. Observou-se correlação estatisticamente significativa entre o número de consultas no pré-natal e o tratamento adequado. Concluiu-se que houve ascensão da notificação dos casos de sífilis na gestação na cidade de Criciúma/SC e que apesar de doença conhecida e de fácil tratamento grande parte das gestantes e seus parceiros não são tratadas de forma adequada.

Syphilis is a systemic disease specially worrying during pregnancy due to the risk of fetal transmission. It can evolve from perinatal death, premature birth, low weight at birth, congenital anomalies and auditory and neurological sequels. This study had the main objective of knowing the prevalence of syphilis in parturients attended in a maternity in the city of Criciúma, Santa Catarina, in the period from January 2012 to December 2016. It is a transversal study, made through the data collect from medical records and Notification files of Syphilis in pregnants. 117 cases of Syphilis have been notified, however only 69 fulfilled the criteria of inclusion and composed the final sample. The prevalence of Syphilis was 0.61 cases per 100 parturients, with progressive notification in the period of study. The average age of patients was 23.62 years old, mainly single (40.6%), multigravida (63.7%), white color (68.1%), with completed elementary school or incomplete high school (40.6%) and housewives (52.2%). 73.2% went on six or more prenatal appointments, there were predominance (69.2%) of high titles of VDRL (≥1:8) in the time of the diagnosis and 75.3% of the pregnants were treated with Benzathine Penicillin G. On the other hand, only 30.4% of the partners were treated. A Statistically significant correlation was observed between the number of appointments in prenatal and the proper treatment. It has been concluded that an ascent in the syphilis cases notification in pregnancy in the city of Criciúma/SC and despite being a well known disease and easy to treat, most of pregnants and their partners are not treated properly.

Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia?

OBJECTIVE: To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy). RESULTS: An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L. CONCLUSIONS: Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures.

Degeneração maligna da endometriose: revisão da literatura / Malignant degeneration endometriosis: literature review

Estima-se que ocorra transformação maligna em 0,3 a 1% dos casos de endometriose, sendo 75% nos ovários. Fatores hormonais, inflamação, predisposição familiar, alterações imunológicas, estresse oxidativo e fatores ambientais são apontados como possíveis fatores de carcinogênese. Estudos demonstram que pacientes com endometriose apresentam aumento do risco de câncer de ovário que pode variar de 1,3 a 1,9, podendo chegar a 2,7 naquelas com endometriose associada à infertilidade. Até o momento não existem ferramentas diagnósticas capazes de identificar quais mulheres estão sob maior risco e o instrumento diagnóstico mais promissor para avaliar a transformação maligna da endometriose parece ser a ressonância nuclear magnética. Esta revisão tem como objetivo avaliar a etiologia e possíveis causas da transformação maligna da endometriose através da realização de uma revisão da literatura.

It is estimated to occur in malignant transformation 0.3 to 1% of cases of endometriosis with 75% in the ovaries. Hormonal factors, inflammation, familial predisposition, immunological changes, oxidative stress and environmental factors are considered possible carcinogenic factors. Studies show that patients with endometriosis have an increased risk of ovarian cancer that can vary from 1.3 to 1.9, reaching 2.7 in those with endometriosis associated with infertility. So far there are no diagnostic tools able to identify which women are at highest risk and the most promising diagnostic tool for assessing the malignant transformation of endometriosis seems to be magnetic resonance. This review aims to evaluate the etiology and possible causes of malignant transformation of endometriosis by conducting a literature review.

Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery.

INTRODUCTION: Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. OBJECTIVE: To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. METHODS: Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. RESULTS: We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. CONCLUSION: The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death.

Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery / Infarto do miocárdio perioperatório em pacientes submetidos à cirurgia de revascularização miocárdica

Introduction: Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. Objective: To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. Methods: Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. Results: We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. Conclusion: The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death. .

Introdução: O infarto do miocárdio perioperatório afeta negativamente o prognóstico dos pacientes submetidos à cirurgia de revascularização do miocárdio e seu diagnóstico esbarra em inúmeras dificuldades, pois a fisiopatologia é diferente da tradicional instabilidade aterosclerótica e o quadro clínico de difícil caracterização. Objetivo: Identificar a frequência de infarto do miocárdio perioperatório e seu desfecho em pacientes submetidos à cirurgia de revascularização do miocárdio. Métodos: Coorte retrospectiva realizada em hospital terciário especializado em cardiologia, de 1 de maio de 2011 a 30 de abril de 2012, que incluiu todos os prontuários contendo registros de cirurgia de revascularização do miocárdio. Para confirmação diagnóstica do infarto do miocárdio perioperatório, foram utilizados os critérios da Third Universal Definition of Myocardial Infarction Resultados: Foram analisados 116 casos. Foi diagnosticado infarto do miocárdio perioperatório em 28 pacientes (24,1%). Número de enxertos e utilização e tempo de circulação extracorpórea foram fatores associados a este diagnóstico e a média de idade foi significativamente mais elevada neste grupo. O critério diagnóstico elevação de troponina I foi positivo em 99,1% dos casos, independentemente do diagnóstico de infarto do miocárdio perioperatório. Não foi encontrada diferença significativa entre tempo de internação hospitalar e em unidade de terapia intensiva nos grupos com e sem esta complicação, porém pacientes com infarto do miocárdio perioperatório evoluíram com pior função ventricular esquerda e mais casos de óbito. Conclusão: A frequência de infarto do miocárdio perioperatório encontrada neste trabalho foi considerada alta e como consequência do mesmo observou-se média mais elevada de troponina I, mais casos de piora da função ventricular esquerda e óbito. .

Diagnosis, classification and treatment of gestational trophoblastic neoplasia.

Gestational trophoblastic neoplasia (GTN) is the term to describe a set of malignant placental diseases, including invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Both invasive mole and choriocarcinoma respond well to chemotherapy, and cure rates are greater than 90%. Since the advent of chemotherapy, low-risk GTN has been treated with a single agent, usually methotrexate or actinomycin D. Cases of high-risk GTN, however, should be treated with multiagent chemotherapy, and the regimen usually selected is EMA-CO, which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. This study reviews the literature about GTN to discuss current knowledge about its diagnosis and treatment.

Diagnosis, classification and treatment of gestational trophoblastic neoplasia / Diagnóstico, classificação e tratamento da neoplasia trofoblástica gestacional

Gestational trophoblastic neoplasia (GTN) is the term to describe a set of malignant placental diseases, including invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Both invasive mole and choriocarcinoma respond well to chemotherapy, and cure rates are greater than 90%. Since the advent of chemotherapy, low-risk GTN has been treated with a single agent, usually methotrexate or actinomycin D. Cases of high-risk GTN, however, should be treated with multiagent chemotherapy, and the regimen usually selected is EMA-CO, which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. This study reviews the literature about GTN to discuss current knowledge about its diagnosis and treatment.

Neoplasia trofoblástica gestacional (NTG) é o termo que descreve o conjunto de anomalias malignas da placenta, incluindo a mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelióide. Ambos a mola invasora e o coriocarcinoma respondem bem à quimioterapia, com taxas de cura superiores a 90%. Desde o advento da quimioterapia, NTG de baixo risco tem sido tratada com monoquimioterapia, pelo geral methotrexate ou actinomicina-D. Casos de NTG de alto risco, contudo, devem ser tratados com poliquimioterapia, e o regime usualmente escolhido é o EMA-CO que combina etoposide, methotrexate, actinomicina-D, ciclofosfamida e vincristina. Esse estudo revê a literatura sobre NTG a fim de discutir os conhecimentos atuais sobre seu diagnóstico e tratamento.

[Frequency of hydatidiform mole in tissue obtained by curettage]. / Frequência de mola hidatiforme em tecidos obtidos por curetagem uterina.

PURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel(®) software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ(2) test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. RESULTS: A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. CONCLUSIONS: The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.

Frequência de mola hidatiforme em tecidos obtidos por curetagem uterina / Frequency of hydatidiform mole in tissue obtained by curettage

OBJETIVO: Determinar a frequência de mola hidatiforme em tecidos obtidos por curetagem uterina. MÉTODOS: Estudo transversal, prospectivo e descritivo que incluiu pacientes submetidas à curetagem uterina por diagnóstico de aborto ou mola hidatiforme cujo material obtido foi encaminhado para exame anatomopatológico. Foram excluídas aquelas que não aceitaram participar da pesquisa, recusando-se a assinar o Termo de Consentimento Informado Livre e Esclarecido. Foram analisadas as seguintes variáveis: achados anatomopatológicos, idade, raça/cor, número de gestações e abortos prévios, idade gestacional no momento do diagnóstico, níveis séricos quantitativos da fração beta da gonadotrofina coriônica humana e achados ultrassonográficos. As variáveis foram empregadas para a verificação com o diagnóstico histológico, considerado o padrão-ouro. Os dados foram armazenados e analisados no software Microsoft Excel® e no programa Epi-Info, versão 6.0 (STATCALC) e os resultados apresentados como frequência (porcentagem) ou média±desvio padrão. Para a associação entre variáveis qualitativas foi usado o teste do χ², e admitiu-se significância estatística quando p<0,05. RESULTADOS: No período, foram realizadas 515 curetagens, das quais 446 compuseram a amostra. A frequência de mola hidatiforme foi de 2,2% (dez casos). A média de idade das pacientes com mola foi 31±10 anos, a maioria era da raça branca e multípara e não tinha antecedente de aborto prévio, mas não houve associação significativa entre essas variáveis. A perda gestacional foi precoce nas pacientes com e sem mola, e as queixas mais comuns em ambos os grupos foram: sangramento vaginal e dor em cólica em hipogástrio. A dosagem sérica quantitativa da fração beta da gonadotrofina coriônica humana foi obtida em 422 casos (413 sem mola hidatiforme e 9 com mola hidatiforme). Os níveis do hormônio foram superiores a 100.000 mUI/mL em 1,9% das pacientes sem mola hidatiforme, e em 44,45% das pacientes com a doença (p=0,00004). Todas as pacientes com esse nível de hormônio tinham suspeita ultrassonográfica de gestação molar e uma delas apresentava também suspeita clínica. Trezentas e trinta e três pacientes foram submetidas a exame ultrassonográfico. Das pacientes com achados ultrassonográficos sugestivos de gestação molar, houve confirmação diagnóstica em cinco (41,7%) casos. Os outros sete (58,3%) eram falso-positivos. Houve associação significativa entre achado ultrassonográfico suspeito de gestação molar e confirmação da doença pela análise anatomopatológica (p=0,0001). Em metade dos casos de mola hidatiforme não havia suspeita da doença pelo quadro clínico, níveis da fração beta da gonadotrofina coriônica humana ou achados ultrassonográficos. CONCLUSÕES: A frequência de mola hidatiforme é baixa e a doença pode não ser suspeitada pelo quadro clínico, pela ultrassonografia e pelo nível sérico da fração beta da gonadotrofina coriônica humana, exigindo análise anatomopatológica dos tecidos obtidos pelo esvaziamento uterino para o seu diagnóstico.

PURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel® software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ2 test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. RESULTS: A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. CONCLUSIONS: The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.

Frequência de microcarcinoma papilífero em doenças benignas da tireóide / Frequency of papillary microcarcinoma in thyroid benign diseases

Objetivo: Conhecer a frequência de microcarcinoma papilífero (MCP) em doenças benignas da tireóide. Métodos: Estudo transversal e retrospectivo, realizado no laboratório Alice de Patologia, na cidade de Criciúma, SC, no período de 1996 a 2006. Foram analisados 636 laudos anatomopatológicos de tireoidectomias totais, dos quais 409 preencheram os critérios de inclusão. Destes, estudou-se as seguintes variáveis: cidade de origem, gênero, idade, doenças benignas associadas ao MCP, tamanho dos tumores, lateralidade, focalidade, localização e invasão das bordas cirúrgicas. A análise estatística foi realizada através do programa EPIINFO versão 6.0. Resultados: Dos 636 laudos estudados, 409 preencheram os critérios de inclusão. Destes, 90,7% (371) eram mulheres e 9,3% (38) homens, sendo a média de idade 48,17 anos. A maioria (95,6%) dos pacientes estudados era de Criciúma. A frequência de MCP em doenças benignas da tireóide foi de 8,8%, sendo a doença de maior coexistência com MCP o bócio multinodular, seguido pelos adenomas foliculares. O diâmetro médio dos tumores foi de 4,7mm, sendo a maioria unilateral (88,9%) e unifocal (91,7%). A variante histológica do MCP encontrada com maior frequência foi a papilífera pura (61,11%). Não houve diferença significativa na localização dos tumores. Na maioria (88,9%) dos casos as bordas cirúrgicas estavam livres de doença. Conclusão: A frequência de MCP em doenças benignas da tireóide é alta no local de realização desta pesquisa, devendo chamar a atenção dos médicos para o seu possível diagnóstico, que na maioria das vezes acaba sendo um achado incidental na análise anatomopatológica de glândulas tireóideas retiradas por doenças aparentemente benignas.

Objective: To assess the frequency of papillary microcarcinoma in benign thyroid diseases. Methods: Retrospective cross-sectional study, conducted in the laboratory of Pathology Alice in the city of Criciúma, SC, from 1996 to 2006. We analyzed 636 reports of pathological total thyroidectomy, of which 409 met the inclusion criteria. Of these, the following variables were studied: city of origin, gender, age, benign diseases associated with papillary microcarcinoma, size of tumors, laterality, focus, location and invasion of the surgical margins. Statistical analysis was performed using the program EPIINFO version 6.0. Results: Of the 636 reports studied, 409 met the inclusion criteria. Of these, 90.7% (371) were women and 9.3% (38) men, with a mean age of 48.17 years. The majority (95.6%) of patients studied was Criciúma. The frequency of papillary microcarcinoma in benign thyroid disease was 8.8%, and the disease of greater coexistence with the papillary microcarcinoma was multinodular goiter, followed by follicular adenomas. The average diameter of tumors was 4.7 mm, the majority being unilateral (88.9%) and unifocal (91.7%). A histologic variant of papillary microcarcinoma found with more frequency was papillary pure (61.11%). There was no significant difference in the location of tumorsMost(88.9%) cases the surgical margins were free of disease. Conclusion: The frequency of MCP in benign thyroid diseases is high in the place of realization of this research, and should draw the attention of doctors for their possible diagnosis, which most often ends up being an incidental finding in the anatomopathological analysis of thyroid glands removed for apparently benign diseases.

Uso racional de medicamentos: relato de experiência no ensino médico da Unesc, Criciúma/SC / Rational use of medicines: report of an experience in medical education at Unesc Criciúma, Santa Catarina State, Brazil

O presente estudo objetivou disseminar entre os alunos do curso de Medicina da Unesc a lógica do Uso Racional de Medicamentos e suas aplicações na prática médica. Utilizou-se como modelo o curso de formação sobre Uso Racional de Medicamentos promovido pela OMS, por meio do método didático-pedagógico da aprendizagem baseada em problemas, a mesma concepção utilizada pelo curso de Medicina da Unesc. Com apoio e financiamento da Diretoria de Pesquisa e da Diretoria de Extensão e Ação Comunitária (Unesc), o trabalho foi desenvolvido a partir de duas vertentes: a primeira visou capacitar acadêmicos do curso de Medicina na lógica do Uso Racional de Medicamentos; a segunda vertente objetivou desenvolver ações educativas na comunidade dos bairros adjacentes à universidade, envolvendo temas como Uso Racional de Medicamentos. Foram capacitados 35 alunos e realizadas intervenções na comunidade que abrangeram 689 pessoas. Os acadêmicos envolvidos neste trabalho passaram a visualizar a prescrição de medicamentos de forma mais racional e ainda adquiriram a noção da importância de priorizar uma lista de medicamentos essenciais, tendo como base condutas pautadas nas melhores evidências disponíveis.

The current study aimed to disseminate the logic of rational use of medicines and its application in medical practice among medical students at UNESC, Santa Catarina State, Brazil. The study's model was the training course on Rational Use of Medicines promoted by the World Health Organization (WHO), using the problem-based teaching-learning method, a strategy adopted by the UNESC School of Medicine in general. With support and funding from the Office of the Dean for Research and the Office of the Dean for Extension and Community Action (UNESC), the project was developed along two lines: first, training undergraduate medical students in the logic of Rational Use of Medicines; second, develop educational activities in the community, in neighborhoods near the university, on themes related to Rational Use of Medicines. Thirty-five students were trained, and community interventions were conducted with a total of 689 community members. The medical students involved in this project began to view prescriptions more rationally and gained a notion of the importance of prioritizing a list of essential drugs, for treatment supported by the best available evidence.

Metástase placentária de câncer de mama: relato de caso / Placental metastasis of breast cancer: case report

O câncer de mama e a neoplasia maligna mais comum durante a gestação. Os autores relatam o caso de uma mulher de 33 anos com câncer de mama com metástase hepática e placentária diagnosticado durante o terceiro trimestre da gestação.

Breast cancer is the most common malignant neoplasm during pregnancy. The authors report the case of a 33-year-old woman with breast cancer with liver and placental metastasis diagnosed during the third trimester of pregnancy.

Colecistectomia aberta com preservação do músculo reto abdominal: pós-operatório menos doloroso? / Preservation of open cholecystectomy with abdominal rectus muscle: less postoperative pain

Objetivo: Observar se a técnica de colecistectomia aberta com preservação do músculo reto abdominal proporcionaaos pacientes um pós-operatório menos doloroso. Métodos: Estudo prospectivo, exploratório e documental de 50 pacientes com diagnóstico clínico e imaginológico compatíveis com colecistopatia crônica calculosa,submetidos à colecistectomia aberta com preservação do músculo reto abdominal, no Hospital São José,em Criciúma/SC, no período de janeiro a julho de 2007. Foram excluídos do estudo pacientes com idade inferiora 13 anos, pacientes com colecistopatia aguda, pacientes com complicações em árvore biliar e pacientes com quadro de peritonite generalizada. Métodos: Quanto ao perfil da amostra, a maioria dos pacientes era do sexo feminino (82%), sendo a média de idade do total de pacientes 50,22 anos. Dentre aequipe de médicos e cirurgiões residentes que participaram das cirurgias, 84% negaram dificuldades técnicas. O número de perfurações de vesícula biliar durante o trans-operatório ocorreu em 20 pacientes (40%). O tempo de internação foi de 2 dias para 49 pacientes e 3 dias para 01 paciente. Quanto à dor no pós-operatório, 68% dos pacientes afirmaram não estar sentindo dor no primeiro dia do pós-operatório, 22% relataram dor branda, 8% dor moderada e 2% dor severa. Conclusões: De acordo com este estudo a dor sentida no pós-operatório foi relatada como mínima ou ausente pela maioria dos pacientes.

Objective: To observe if open cholecystectomy with rectus abdominal muscle preservation propitiate for patients a less pain in postoperative.Methods: Prospective, exploratory and documental study of 50 patients with clinical and image diagnosis compatible with chronic calculi cholecystitis treated with open cholecystectomy with rectus muscle preservation, in São José Hospital, Criciúma/SC, from January until July of 2007. It was excluded patients under of 13 years old, patients with acute cholecystitis, patients with complications in bile duct and patients with generalized peritonitis. Results: About sample profile, most patients werefemale sex (82%) and the average age of total patients was 50,22 years. In the staff of surgeons doctors and resident surgeons doctors that participate of surgeries, 84% declared nonexistent technique difficulties. The number of gallbladder perforations during the surgery occurred in 20 patients (40%). The time of internment was 2 days for 49 patients and 3 for 01 patient. Aboutthe pain result in postoperative, 68% of patients said that they were not felling pain in first day of postoperative,22% report light pain, 8% moderate pain and 2% severe pain. Conclusions: According to this study the pain felton postoperative was minimum or absent for the most patients.

Fator prognóstico do infarto agudo do miocárdio com supradesnível de ST / Prognosis factor of acute myocardial infarction with ST elevation

Objetivos: Conhecer a relação entre a área cardíaca infartada observada no eletrocardiograma e os níveis séricos dos marcadores isquêmicos CPK e CK-MB com o desfecho dos pacientes.Métodos: Estudo transversal, documental, observacional e retrospectivo abrangendo 96 pacientes infartados atendidos no Hospital São José, em Criciúma, SC, no período de 2003 a 2005. As variáveis estudadas foram sexo, idade, área cardíaca infartada, nível de enzimas e desfecho dos pacientes. Resultados: Dos pacientes estudados, 73 (76,04%)eram do sexo masculino e 23 (23,96%) feminino com média de idade de 60,1 anos. Observou-se maior prevalênciada mortalidade no sexo feminino (p=0,033) e em idades mais avançadas (p=0,02). Houve maior freqüênciade infarto agudo do miocárdio na parede inferior, e maior mortalidade naqueles com lesão da parede ântero- lateral. Os níveis dos marcadores isquêmicos forammaiores no sexo feminino e nos pacientes que evoluíram para óbito, não mostrando relação com a mortalidadeem uma parede infartada específica.Conclusão: Das variáveis estudadas, sexo e idade foram estatisticamente significativas quando relacionadas com o desfecho dos pacientes. Na análise dos níveis enzimáticos em uma parede cardíaca específica, não se observou associação significativa com óbito.

Objectives: To know the relation between the infarct cardiac area detected in electrocardiogram andserum levels of the ischemic markers CPK and CKMB with outcome of the patients. Methods: Transversal, document, observational and retrospective study ranging 96 infarcted patients checked in São José Hospital in Criciúma City, SC, from 2003 to 2005. The variables studied were sex, age, infarct cardiac area, enzymes level and outcome of the patients. Results: From the studied patients, 73 (76,04%) weremale and 23 (23,96%) female, with median age of 60,05 years. It was observed more prevalence of the mortality in women (p=0,33) and in advanced ages (p=0,02). There were most frequency of acute myocardial infarction in the inferior wall and more mortality on those with ântero-lateral lesion. The ischemic markers levels werehigher in females and in patients who died, not showing relation with mortality in a specific infarcted wall. Conclusion: From the studied variables, sex and age were statistically significant when related with the outcome of the patients. In the enzymes level analysis of aspecific cardiac wall it wasn’t observed significant relation with death.