Neoplastic and non-neoplastic thyroid lesions in surgical material: historical review of five decades in São Paulo, Brazil.

AIMS AND BACKGROUND: The goal of the study was to report and discuss the neoplastic and non-neoplastic diseases of the thyroid gland present in a historical series of surgical material examined during the period 1945 to 1989 at the Pathology Department of the São Paulo University Medical School. METHODS: Records of 281,175 cases were reviewed to select those which affected the thyroid gland. The slides of these selected cases were analyzed and classified according to current terminology. RESULTS: Non-neoplastic lesions comprised 86.68% of the cases (n = 7024), and most of them were nodular goiter (n = 6458). Neoplastic lesions were divided into two groups: primary and metastatic. Of 1072 primary neoplasms, 530 were benign and 542 were malignant. Of the malignant neoplasms, papillary and follicular were the most frequent types (n = 201 and 187, respectively), followed by undifferentiated (n = 86), Hürthle (n = 46), medullary (n = 16) and others (n = 6). Of 8 metastatic neoplasms, 4 were from and undetermined primary epidermoid carcinoma. CONCLUSIONS: We concluded that owing to the high incidence of neoplastic lesions (13.32%), half of which were malignant, examination of the thyroid gland should be done with strict criteria in view of the therapeutic and prognostic implications.

Neoplastic and non-neoplastic thyroid lesions in autopsy material: historical review of six decades in São Paulo, Brazil.

AIMS AND BACKGROUND: The aim of the study was to report and discuss a historical series of neoplastic and non-neoplastic lesions of the thyroid gland obtained at autopsy that were examined between 1931 and 1989 at the Pathology Department of the Medical School of the University of São Paulo. METHODS: Records of 145,043 cases were reviewed to select those affecting the thyroid gland. The slides of these selected cases were analyzed and classified according to the current terminology. RESULTS: Non-neoplastic lesions comprised 91.62% of the cases (n = 4647), and most of them were adenomatous goiter (n = 3014). Neoplastic lesions were divided into two groups: primary and metastatic. Of the 282 primary tumors, 135 were benign and 147 were malignant. Among the malignant neoplasms, the most frequent types were follicular, papillary and undifferentiated (n = 39, 36 and 29, respectively). The most frequent tumor types among the metastatic neoplasms were lymphoproliferative processes and carcinomas (n = 67 and 34, respectively). CONCLUSIONS: We conclude that, because of the high frequency of neoplastic lesions (8.38%), 68.24% of which were malignant, detailed examination of the thyroid by pathological methods should be carefully and systematically performed for the accurate detection of thyroid lesions, especially carcinomas.

[The prospects of postgraduate education in plastic and reconstructive surgery]. / Algumas notas sobre as perspectivas da formação post-graduada em cirurgia plástica e reconstructiva.

The author looks at the conditions to accede a Plastic Surgery Residency and briefly notes the EC institutions devoted to the restructuring of training. Some recommendations in the field of curricular contents and about organization of teaching are pointed out, namely the efforts to establish a standard of Plastic Surgical Education and to raise a quality control system of Residency Programmes.

[History of the treatment of fractures of the face]. / Contribuiçao para a história do tratamento das fracturas da face.

Throughout most of recorded human history, facial fractures have received either no treatment what so ever or only rudimentary surgical attention. The treatment of facial fractures has made more progress over the past two decades than in the entire two millenia before that. The authors describe how facial fractures have been treated since the New Kingdom in Ancient Egypt until today, with the methods of Stable Internal Fixation.

Saddle nose: our approach to the problem.

Saddle nose is usually caused by a trauma or by excessive resection of the septal cartilage. Nevertheless, there are other, less frequent causes of injury, such as congenital, syphilis, leishmaniosis, and leprosy. Within this context, it is very likely to see widening of the bony bridge and dropping of the tip of the nose. For this clinical status, we found extremely satisfactory a therapy in which we use a dorsum cartilage graft, followed by narrowing of the nasal bridge and shortening of the nose. To achieve this aim, different kinds of materials were employed. The authors usually prefer rehydrated (0.9% saline solution) human costal cartilage. This material was used in a study of a series of patients with saddle nose in which we used open rhinoplasty and cartilage homografts.

[Incidence of adrenalitis in necropsy material]. / Incidência de adrenalites em material de necropsia.

In the necropsy material of the Medical School of the University of São Paulo, collected between 1931 and 1981, consisting of 131,466 post-mortem examinations, there were 254 (0.2%) cases of adrenalitis, 185 male and 69 female. In 161 of these cases the affection was bilateral, in 46 it was unilateral and in 47 cases this information is lacking. In 111 cases (43.7%), the adrenalitis was caused by tuberculosis, in 86 cases (33.8%), by South American blastomycosis, in three cases (1.2%) by histoplasmosis, in two (0.8%) by Salmonellosis, in two (0.8%) by cytomegalovirus infection and in one (0.4%) by leishmaniasis. The high number of cases with tuberculosis and paracoccidioidomycosis of adrenal glands is due to high incidence of these infections in Brazil.

Thyroid papillary carcinoma lipomatous type: report of two cases.

The authors present two cases of a new variant of papillary carcinoma of the thyroid gland with an unusual lipomatous component. The first case occurred in a 50-year-old woman: the thyroid gland showed lipomatous foci in the stroma of the papillary carcinoma. The second case occurred in a 38-year-old man with the same lipomatous component appearing in small foci. In both cases, the lipomatous tissue was found within the stroma. As far as we known, there are only tree other reports of this type of thyroid gland carcinoma in the literature.

[Retrospective analysis of the incidence of midline supratentorial neoplasms in children and young patients: craniopharyngiomas, hypophyseal and pineal neoplasms]. / Análise retrospectiva da incidência de neoplasias supratentoriais da linha mediana em crianças e jovens: craniofaringeomas, neoplasias da hipófise e pineal.

The authors analyzed, in a retrospective study made at the Pathology Department of the Medical School of the University of São Paulo, 1632 cases of intracranial neoplasms in a period of 50 years (1931-1981). The investigation concentrated on 592 cases (36.2%) of patients with age ranging from 0 to 20 years. The overall number of craniopharyngiomas in this group was 21 (3.5%); 8 cases (1.35%) of hypophyseal neoplasms, and 4 cases (6%) of pineal neoplasms. Neoplastic infiltration of the hypophysis and pineal was present in 24 cases (4.0%). No metastases were observed. The description and importance of these findings, and their correlation with data from other authors are presented.

The prevalence of unsuspected thyroid pathology in 300 sequential autopsies, with special reference to the incidental carcinoma.

Three-hundred whole thyroid glands were collected at autopsy from patients who had no known clinical history of thyroid disease, and who varied from 13 to 82 years of age; 200 were male and 100 female. Thyroid glands were weighed, measured, and examined after previous formalin fixation. Histologic examination was done in 16 areas from both lobes and isthmus, and divided into three levels, anterior, medial, and posterior. All areas suspected of neoplasia macroscopically were identified and studied microscopically; other areas were collected randomly for microscopic examination in the proportion of one fragment per 5 grams of tissue. In all cases both benign and malignant neoplasias were an incidental finding, seen in 6.6% of the cases and with no relation to the patient's main disease. Overall, there were malignant neoplasias in 2.33% but occult carcinoma comprised 1% of the cases. The incidence of other thyroid pathologies, all of them unrelated to the main disease of the patient, are also reported.

Study in necropsy material of "cause-specific mortality" in diabetics, in São Paulo-Brasil.

Specific causes of death in diabetic patients was studied in retrospective work from necropsies performed at the Medicine School of the University of São Paulo from 1931 until 1989. From 145,043 necropsies, 813 indexed cases were found: 449 females (55.2%) and 364 males (44.8%). The race ratio of patients was: 584 (71.8%) white, 208 (25.6%) negro and 21 (2.6%) asiatic. The predominant age of death incidence was between the fifth and sixth decades. The main causes reported were infections (42.68%), coma (12.79%), neurologic involvement (11.56%) and cardiac diseases (11.07%); indeterminate causes of death were related in 7.4% of cases. Our results differ from the others of literature mainly in two points: the high prevalence of infectious diseases and the proportional low incidence of cardiopathies. We concluded that, in our casuistic, infectious diseases in diabetic patients represent an important cause of death establishing important clinical parameters for their care.

Later complications on diabetic patients: nephropathies in necropsy material.

The purpose of the present study was to analyze in detail the kidney lesions of diabetic patients. Revision of the histopathologic aspects of this nephropathy was performed, seeking to approach the pathophysiology of its formation. In 200 consecutive necropsies of cadavers of diabetic patients examined at the Pathology Department of the Medical School of the São Paulo University, some degree of nephropathy was found in 158 cases. The slides from paraffin sections of these cases were reviewed according to a morphologic protocol previously established. Diffuse, nodular and mixed glomerulosclerosis were encountered in 42.2%, 21.5% and 5.7% respectively. Subcapsular drop and exudative lesion appeared in 12.7% and 15.2% of the cases. We also encountered arteriosclerosis in 81.6%, arteriolosclerosis in 88.6%, necrotizing papillitis in 11.4% and acute and chronic pyelonephritis in 23.4% and 20.9% respectively. We concluded that glomerular and vascular hyalin alterations were the most frequent findings in diabetic patients.

A proposito de um caso de difteria. / Apropos of a diphtheria case

Os autores apresentam um caso de difteria em crianca de tres anos de idade, aparentemente nao vacinada. Sao apresentados dados epidemiologicos referentes a essa doenca validos para o Estado de Sao Paulo, bem como, sao feitas consideracoes quanto ao estado imunitario de crianca vacinada

Reuniao anatomo-clinica do Instituto da Crianca. / Anatomo-clinical meeting of the Instituto da Crianca

Os autores descrevem o caso de uma crianca de 3 anos e 8 meses de idade com sinais e sintomas de hipertensao portal. A necropsia revelou ser a causa uma doenca veno-oclusiva hepatica com comprometimentos, em extensao, das veias supra-hepaticas. A crianca faleceu 7 meses apos a internacao. E comentado o diagnostico diferencial com a Sindrome de Budd-Chiari, bem como os aspectos rediologicos dos quadros com hipertensao portal