Association of human papillomavirus (HPV), p16, p53 and p63 expression with non-bilharzia-associated squamous cell carcinoma of the bladder and algorithm construction for histopathological grading prediction.

OBJECTIVE: To investigate the expression of human papillomavirus (HPV), p16, p53, and p63 in non-schistosomiasis-related squamous cell carcinoma of the bladder and to develop an accurate and automated tool to predict histological classification based on clinicopathological features. METHODS: Twenty-eight patients with primary bladder pure squamous cell carcinoma who underwent cystectomy or transurethral resection of bladder tumor (TURBT) for bladder cancer between January 2011 and July 2017 were evaluated. Clinical data and follow-up information were obtained from medical records. Formalin-fixed, paraffin-embedded surgical specimens were used for immunohistochemical staining for p16, p53, and p63. Human papillomavirus detection was evaluated by PCR. Statistical analysis was performed, and statistical significance was set at p<0.05. Finally, decision trees were built to classify patients' prognostic features. Leave-one-out cross-validation was used to test the generalizability of the model. RESULTS: Neither direct HPV detection nor its indirect marker (p16 protein) was identified in most cases. The absence of p16 was correlated with less aggressive histological grading (p=0.040). The positive p16 staining detection found only in pT1 and pT2 cases in our sample suggests a possible role for this tumor suppressor protein in the initial stages of bladder squamous cell carcinoma. The decision trees constructed described the relationship between clinical features, such as hematuria/dysuria, the level of tumor invasion, HPV status, lymphovascular invasion, gender, age, compromised lymph nodes, and tumor degree differentiation, with high classification accuracy. CONCLUSION: The algorithm classifier approach established decision pathways for semi-automatic tumor histological classification, laying the foundation for tailored semi-automated decision support systems for pathologists.

[Effect of cholestasis on renal morphological and functional aspects after nephrectomy]. / Efeito da colestase nos aspectos funcionais e morfológicos renais após nefrectomia.

OBJECTIVE: The removal of one kidney results in a compensatory growth of the remnant kidney. However, the mechanism that underlies this hypertrophic response is not understood. In this study we assessed the influence of obstructive jaundice on renal morphology and function after unilateral nephrectomy. METHODS: Forty Wistar rats (250-300 g) were randomly divided into four groups: Group 1--sham operation, Group 2--right nephrectomy, Group 3--common bile duct ligation, Group 4--common bile duct ligation and right nephrectomy. After 20 days, blood was collected for biochemical studies and the animals were killed. Their kidneys and livers were removed and weighed. Histological evaluation of both organs was carried out. RESULTS: No difference in the kidney/body weight ratio was observed for animals undergoing right nephrectomy (Groups 2 and 4) (p=0.4). Animals submitted to bile duct ligation only (Group 3) presented a higher kidney/body weight ratio than animals submitted to sham operation (Group 1) (p=0.011). Vasodilatation was identified in the medulla of the hypertrophied kidneys and histological alterations were found in the livers of the jaundiced animals. Cirrhosis occurred only in nephrectomized rats. CONCLUSION: Cholestasis does not affect the weight, function or the compensatory renal growth of the remnant kidney after unilateral nephrectomy.

Association of human papillomavirus (HPV), p16, p53 and p63 expression with non-bilharzia-associated squamous cell carcinoma of the bladder and algorithm construction for histopathological grading prediction

ABSTRACT Objective To investigate the expression of human papillomavirus (HPV), p16, p53, and p63 in non-schistosomiasis-related squamous cell carcinoma of the bladder and to develop an accurate and automated tool to predict histological classification based on clinicopathological features. Methods Twenty-eight patients with primary bladder pure squamous cell carcinoma who underwent cystectomy or transurethral resection of bladder tumor (TURBT) for bladder cancer between January 2011 and July 2017 were evaluated. Clinical data and follow-up information were obtained from medical records. Formalin-fixed, paraffin-embedded surgical specimens were used for immunohistochemical staining for p16, p53, and p63. Human papillomavirus detection was evaluated by PCR. Statistical analysis was performed, and statistical significance was set at p<0.05. Finally, decision trees were built to classify patients' prognostic features. Leave-one-out cross-validation was used to test the generalizability of the model. Results Neither direct HPV detection nor its indirect marker (p16 protein) was identified in most cases. The absence of p16 was correlated with less aggressive histological grading (p=0.040). The positive p16 staining detection found only in pT1 and pT2 cases in our sample suggests a possible role for this tumor suppressor protein in the initial stages of bladder squamous cell carcinoma. The decision trees constructed described the relationship between clinical features, such as hematuria/dysuria, the level of tumor invasion, HPV status, lymphovascular invasion, gender, age, compromised lymph nodes, and tumor degree differentiation, with high classification accuracy. Conclusion The algorithm classifier approach established decision pathways for semi-automatic tumor histological classification, laying the foundation for tailored semi-automated decision support systems for pathologists.

O que dizem as informações sobre mortalidade dos Registros Hospitalares de Câncer (RHC) em hospital de referência de Minas Gerais, 2016-2017 / What the information on mortality from the Hospital Cancer Registry (RHC) reveals about a reference hospital in Minas Gerais, 2016-2017

Resumo Introdução A qualidade das informações dos Registros Hospitalares de Câncer (RHC) necessita de avaliação quanto à cobertura, completitude e concordância da causa básica(CB) com o Sistema de Informações sobre Mortalidade (SIM). Objetivo Avaliar a qualidade dos RHC nas duas unidades hospitalares do Instituto Mário Penna: Hospitais Mário Penna (HMP) e Luxemburgo (HL), Belo Horizonte, Minas Gerais, em 2016 e 2017, nos atributos mencionados. Método Por captura-recaptura (RHC x RHC), avaliaram-se, por unidade, cobertura, completitude da variável "óbito por câncer" e concordância da a (CB) com a causa da pesquisa (CP). Por relacionamento determinístico (RHC x SIM) avaliaram-se cobertura e concordância da CB. Resultados A cobertura dos RHC foi boa eexcelente (88,8% e 95,3%); a completitude foi ruim (34,6% e 32,6%) no HMP e HL respectivamente; por capítulo da CID-10, não houve concordância da CB com a CP. Observaram-se excelentes cobertura (94,7%) e concordância (94,5%) entre CP e SIM; observou-se sub-registro de 38 neoplasias no SIM, com reclassificação de causas pouco úteis. Conclusão A aplicação das técnicas de captura-recaptura e relacionamento determinístico contribuiu para a melhora da qualidade da informação dos RHC, com redução da incompletude nos RHC e correção da CB nos RHC e no SIM.

Abstract Bakground The quality of information from the Hospital Cancer Records (HRC) needs to be evaluated regarding coverage, completeness and agreement between the underlying cause (UC) as registered in the HRC and the Mortality Information System (SIM). Objective To assess the quality of the HRC in the two Instituto Mário Penna hospitals: Mário Penna (HMP) and Luxemburgo (HL) in Belo Horizonte, Minas Gerais, between 2016-2017. Method By capture-recapture (RHC x RHC), we assessed coverage, completeness of the "cancer death" variable and agreement between underlying cause (UC) with the cause of the research (CR), in each hospital. Deterministic relationship (RHC x SIM) was used to asses UC coverage and agreement between systems. Results The coverage of deaths at the HRC was good/excellent (88.8% and 95.3%); completeness was poor (34.6% and 32.6%) in HMP and HL respectively; per ICD-10 chapter, there was no agreement between CB and CP. Excellent coverage (94.7%) and agreement (94.5%) of CR and SIM were observed; 38 neoplasms were under-reported in the SIM, with reclassification of less useful causes. Conclusion Applying capture-recapture and deterministic linkage techniques contributed in improving the quality of information in the HRC, with a reduction in incompleteness in the HRC and correction of the UC in both HRC and SIM.

[Visceral leishmaniasis and B fulminant hepatitis association: case report]. / Associação de leishmaniose visceral e hepatite B de curso fulminante: relato de um caso.

The case of a 20-year-old man with hepatoesplenomegaly, fever and severe hepatic insufficiency is reported. Histopathological and immunohistochemical studies of tissue specimens obtained at autopsy led to diagnosis of visceral leishmaniasis and fulminant hepatitis B. The authors pointed out a possible influence of immunological response related with visceral leishmaniasis in development of severe hepatic involvement by hepatitis B virus.

Expression of P16 in NUT carcinomas with no association with human papillomavirus (HPV).

NUT carcinoma (NC) is a rare malignant neoplasm usually located in the midline, including the upper aerodigestive tract. NC is an aggressive and highly lethal type of carcinoma. It is defined by the rearrangement of the nuclear protein in the testis (NUT) gene on chromosome 15q14. In most cases, the NUT is involved in a balanced translocation with the BRD4 gene on chromosome 19p13.1, an event that creates a BRD4-NUT fusion gene. The relationship between the human papillomavirus (HPV), p16, and upper aerodigestive tract cancer has been long postulated. In this study, we evaluated the relationship of the p16 expression in 4 cases of NCs and its eventual association with HPV. All 4 cases presented typical histopathologic findings with nuclear positivity of the NUT protein and strong expression for p16. None of these cases, however, showed an association with HPV evaluated by polymerase chain reaction. Despite the expression of p16, this negative result for HPV indicates that HPV infection probably does not play a role in the pathogenesis of NC.

Effect of the period of extrinsic mechanical compression following sclerotherapy in veins in rabbit ears.

PURPOSE: Research whether a post-sclerotherapy venous compression period of up to 120 hours is sufficient to avoid reperfusion in treated veins; whether there is a relationship between the inflammatory intensity in venous walls and adjacent tissue and the size of venous thrombosis; whether the intensity of the post-sclerotherapy inflammation varies with the period of compression; whether there is a relationship between the presence of hemosiderin in the tissues adjacent to the sclerosing blood vessels and venous blood clots. METHODS: Twenty eight rabbits, all male, were utilized, distributed into four groups (0, 24, 72 and 120). All the animals were administered with 0.25 ml of 1% polidoconal solution and, as a control, 0.25 ml of 0.9% sodium chloride solution in the marginal dorsal vein of the right and left ears, respectively. Mechanical compression was applied to the perfused stretch of the vein, except for the animals in group 0. The period of compression varied from 0 to 120 hours in the groups. An anatomopathological examination of the section of the right and left marginal dorsal veins of all the animals was conducted. RESULTS: There was no significant difference among the various compression periods, both in terms of the degree of vein thrombosis and in the inflammatory intensity in both ears of the various groups. A positive and significant correlation was observed between the inflammatory intensity and the size of the thrombus and in the occurrence of thrombi and hemosiderin. CONCLUSIONS: A compression period of up to 120 hours is not sufficient to prevent reperfusion in sclerosing blood vessels. The intensity of tissue inflammation is related to the size of the thrombus, but not to the compression period. The presence of hemosiderin in the tissues adjacent to the vessels subjected to sclerosis is related to the presence of venous coagulation.

VIPoma pancreático tratado com pancreatectomia distal e preservação esplênica com ligadura da artéria esplênica / Pancreatic VIPoma treated with distal pancreatectomy and splenic preservation with ligature of splenic artery

O VIPoma é um tumor neuroendócrino de baixa malignidade derivado das células das ilhotas não-beta do pâncreas, apresenta incidência de 1:10.000.000 pessoas na população e sua localização mais comum é no corpo e cauda do pâncreas. Seu tratamento curativo é cirúrgico, sendo geralmente realizada a pancreatectomia distal com esplenectomia. O caso relatado foi o de uma paciente do sexo feminino, de 31 anos, diagnosticada com VIPoma pancreático. O tratamento realizado foi a pancreatectomia distal com preservação esplênica e ligadura da artéria esplênica. A preservação esplênica diminui a morbidade perioperatória, sem prejudicar o resultado oncológico nos tumores de baixo grau de malignidade.

VIPoma is a low grade malignancy neuroendocrine tumor derived from non-beta pancreatic islet cells, it has an incidence of 1:10.000.000 individuals in the general population and its commoner location is in the body and tail of the pancreas. The curative treatment is surgery, and distal pancreatectomy with splenectomy is usually the employed technique. The case reported was of a female patient, 31 years-old, diagnosed with pancreatic VIPoma. The chosen treatment was distal pancreatectomy with splenic preservation and ligature of the splenic artery. Splenic preservation reduces the perioperatory morbidity, with no prejudice to the oncologic effect in the low grade malignancy tumors.

Device for craniocervical isolation in rabbits.

PURPOSE: To evaluate the craniocervical isolation collar, for use in rabbits, with regard to the following aspects: effectiveness of the craniocervical attachment for up to 120 hours; ease of handling; freedom of the animal to move about and ingest food; and the physical integrity of the animal during and after use of the device. METHODS: Starting from an Elizabethan collar, a craniocervical collar was prepared for use in rabbits with the following modifications: a wide cut in the device in the shape of a half-moon, coinciding with the animal's mouth; inner division of the device into two compartments to individually isolate and immobilize the ears; multiple perforations in the upper compartment for better ventilation; adaptation of the cervical-thoracic band to attach the collar to the cervical region, keeping the fasteners on the animal's back. The device was used on 18 male New Zealand rabbits for up to 120 consecutive hours. RESULTS: The device was effective in the craniocervical isolation and separation of ears in rabbits without interfering with the animals' respiration, ability to swallow food, or causing physical trauma, while allowing the animals to move about freely and rest comfortably. Attaching and removing the device was easy and quick and it remained in place for up to 120 hours without the need to reposition it. CONCLUSION: The modified craniocervical isolation collar made it possible to conduct the experiment with isolation of the rabbits' ears, ease of handling, and without causing limitations in relation to the animals' ability to eat and move about freely.

[Local recurrence in soft tissue sarcoma: prognostic factors]. / Recidiva local nos sarcomas de tecidos moles: fatores prognósticos.

OBJECTIVE: To determinate the prognostic factors associated with the local relapse in patients treated for soft tissue sarcoma in extremities. METHODS: Retrospectively, 30 patients were evaluated after being treated with surgical resection of soft tissue sarcoma located in extremities, with a outcome of 36,5 +/- 12,2 months. The prognostic factors evaluated were: age, sex, location, depth, location in the anatomic compartments, size, tumor previous manipulation, surgical margins, grade of histological malignance, presence of histological necrosis or histological vascular invasion. These factors were correlated with the local relapse of the tumor with a univariated and multivariated analysis with significance when p = 0,05. RESULTS: Local relapse presented significant correlation in univariated and multivariated analysis with extra-compartimental location (p = 0,001) and with high grade histological malignance (p = 0,001). There was no significant association with age (p = 1,000), sex (p = 1,000), body location (p = 0,544), depth (p = 0,288), size (p = 0,694), surgical margins (p = 0,384), previous manipulation (p = 0,461), necrosis (p = 0,461) or with the presence of vascular invasion (p = 1,000). CONCLUSION: Local relapse presents correlation with extra-compartimental location and with high grade malignancy tumors.

Obstrução duodenal por mucosa gástrica heterotópica / Duodenal obstruction for heterotopic gastric mucosa

A mucosa gástrica heterotópica (MGH) é uma entidade rara, com malignização incomum, descrita em todo o trato gastrointestinal e fora dele. O relato é de uma mulher de 37 anos, com queixa de dor epigástrica associada a vômitos pós-prandiais com três meses de evolução, causado por MGH localizada na quarta porção duodenal. Submetida à ressecção do seguimento acometido, encontra-se em acompanhamento sem queixas ou sinais de recidiva. A MGH deve ser lembrada como um diagnóstico diferencial nos sangramentos e obstruções duodenais; a ressecção endoscópica ou cirúrgica, se factível, deve ser realizada com o intuito terapêutico.

The heterotopic gastric mucosa (HGM) is a rare event, with uncommon malignant, described throughout the gastrointestinal tract and beyond. The report is about a 37 years-old female, with epigastric pain associated with postprandial vomiting with three months of evolution, caused by HGM located in the fourth portion of the duodenum. The patient underwent resection of the affected segment and since then there has been no complaints or signs of recurrence. The HGM should be remembered as a differential diagnosis in bleeding and duodenal obstruction. The endoscopic or surgical resection, if feasible, should be performed with therapeutic purposes.

Efeito do tempo da compressão mecânica extrínseca após escleroterapia em veias de orelhas de coelhos / Effect of the period of extrinsic mechanical compression following sclerotherapy in veins in rabbit ears

PURPOSE: Research whether a post-sclerotherapy venous compression period of up to 120 hours is sufficient to avoid reperfusion in treated veins; whether there is a relationship between the inflammatory intensity in venous walls and adjacent tissue and the size of venous thrombosis; whether the intensity of the post-sclerotherapy inflammation varies with the period of compression; whether there is a relationship between the presence of hemosiderin in the tissues adjacent to the sclerosing blood vessels and venous blood clots. METHODS: Twenty eight rabbits, all male, were utilized, distributed into four groups (0, 24, 72 and 120). All the animals were administered with 0.25 ml of 1 percent polidoconal solution and, as a control, 0.25 ml of 0.9 percent sodium chloride solution in the marginal dorsal vein of the right and left ears, respectively. Mechanical compression was applied to the perfused stretch of the vein, except for the animals in group 0. The period of compression varied from 0 to 120 hours in the groups. An anatomopathological examination of the section of the right and left marginal dorsal veins of all the animals was conducted. RESULTS: There was no significant difference among the various compression periods, both in terms of the degree of vein thrombosis and in the inflammatory intensity in both ears of the various groups. A positive and significant correlation was observed between the inflammatory intensity and the size of the thrombus and in the occurrence of thrombi and hemosiderin. CONCLUSIONS: A compression period of up to 120 hours is not sufficient to prevent reperfusion in sclerosing blood vessels. The intensity of tissue inflammation is related to the size of the thrombus, but not to the compression period. The presence of hemosiderin in the tissues adjacent to the vessels subjected to sclerosis is related to the presence of venous coagulation.

OBJETIVO: Pesquisar se o tempo de compressão venosa de até 120 horas pós-escleroterapia é suficiente para evitar reperfusão nas veias tratadas; se há relação entre a intensidade inflamatória na parede venosa e tecidos adjacentes e o tamanho do trombo venoso; se a intensidade da inflamação pós-escleroterapia varia com o tempo de compressão; se há relação entre a presença de hemossiderina nos tecidos adjacentes ao vaso esclerosado e coágulo venoso. MÉTODOS: Utilizaram-se 28 coelhos, machos, distribuídos em quatro grupos (0, 24, 72 e 120). Em todos os animais foram administrados 0,25 ml de solução de polidocanol 1 por cento e, como controle, 0,25 ml de solução de cloreto de sódio 0,9 por cento na veia marginal dorsal das orelhas direita e esquerda, respectivamente. Realizou-se compressão mecânica em trecho da veia perfundida, exceto nos animais do grupo 0. O tempo de compressão variou de 0 a 120 horas nos grupos. Realizou-se exame anatomopatológico de trecho das veias marginais dorsais direita e esquerda de todos os animais. RESULTADOS: Não houve diferenças significativas nos diversos tempos de compressão, tanto no grau de trombose venosa como na intensidade inflamatória, em ambas as orelhas, nos diversos grupos. Observou-se correlação positiva e significativa entre intensidade inflamatória e tamanho do trombo e na ocorrência de trombos e hemossiderina. CONCLUSÕES: O tempo de até 120 horas de compressão não é suficiente para evitar reperfusão nos vasos esclerosados. A intensidade da inflamação nos tecidos tem relação com o tamanho do trombo, mas não com o tempo de compressão. A presença de hemossiderina nos tecidos adjacentes ao vaso submetido à esclerose está relacionada com a presença de coágulo venoso.

Tumor sólido pseudopapilar do pâncreas (Tumor de Frantz): estudo retrospectivo e revisão da literatura / Tumor solid pseudopapilary of the pancreas Frantz Tumor: retrospective study and literature review

Introdução: o Tumor de Frantz ou tumor sólido pseudopapilar do pâncreas (TSPPP) foi primeiramente descrito em 1959. O escopo do presente estudo é relatar quatro casos e revisar a literatura afim. Métodos: estudo retrospectivo de quatro casos de TSPPP, operados e acompanhados de novembro de 2002 a março de 2010 e revisão da literatura relacionada. Resultados: todas as pacientes eram do sexo feminino, idade de 20 a 33 anos, com predomínio de queixas inespecíficas; 50% dos tumores foram encontrados no processo uncinado. O tamanho das lesões variou de 6,0 a 14,0cm em seu maior eixo. Foram realizadas duas enucleações, uma duodenopancreatectomia e uma pancreatectomia corporal com anastomose pancreatojejunal. O seguimento clínico das quatro pacientes não evidenciou sinais clínicos ou radiológicos de recidiva tumoral. O TSPPP é composto por células relativamente monomórficas que expressam marcadores epiteliais, mesenquimais e endócrinos. O tumor apresenta distribuição aleatória no pâncreas, sem predileção por topografia específica. Discussão: o TSPPP é um tumor raro, que tem sido mais descrito nas últimas décadas. Apresenta agressividade local, com baixo grau de malignidade, e tende a um prognóstico favorável após tratamento cirúrgico. Acredita-se que sua origem envolve um fator hormonal, e as alterações genéticas a ele relacionadas diferem daquelas dos adenocarcinomas de pâncreas.

Introduction: Frantzs Tumor or solid pseudopapillary tumor of the pancreas (SPPTP) was first described in 1959. The aim of this study is to present four cases of SPPTP and a review of the literature. Methods: retrospective analysis of four cases of SPPTP, which were operated and then followed from November 2002 to March 2010, and review of the related literatures. Results: all patients were female, aged from 20 to 33 years, with predominantly unspecific symptoms. 50% of the tumors were located on the uncinated process. Size ranged from 6,0 to 14,0cm. There were performed two enucleations, one pancreaticoduodenectomy and one body pancreatectomy with pancreato-jejunal anastomosis. Follow up of all four patients has not shown any clinical or radiologic signs of tumoral recurrence. SPPTP are composed of mainly monomorphic cells, which express ephitelial, mesenquimal and endocrine markers. The tumor presents a random distribution, without preference for a specific topography. Discussion: SPPTP is a rare tumor, which has been more described in the last decades. It is locally aggressive, has a low degree of malignancy, and tends to a favorable prognosis after surgical treatment. There?s supposed to be an hormonal factor, and its genetic alterations differ from those of pancreatic adenocarcinoma.

Device for craniocervical isolation in rabbits / Dispositivo para isolamento crânio-cervical em coelhos

PURPOSE: To evaluate the craniocervical isolation collar, for use in rabbits, with regard to the following aspects: effectiveness of the craniocervical attachment for up to 120 hours; ease of handling; freedom of the animal to move about and ingest food; and the physical integrity of the animal during and after use of the device. METHODS: Starting from an Elizabethan collar, a craniocervical collar was prepared for use in rabbits with the following modifications: a wide cut in the device in the shape of a half-moon, coinciding with the animal's mouth; inner division of the device into two compartments to individually isolate and immobilize the ears; multiple perforations in the upper compartment for better ventilation; adaptation of the cervical-thoracic band to attach the collar to the cervical region, keeping the fasteners on the animal's back. The device was used on 18 male New Zealand rabbits for up to 120 consecutive hours. RESULTS: The device was effective in the craniocervical isolation and separation of ears in rabbits without interfering with the animals' respiration, ability to swallow food, or causing physical trauma, while allowing the animals to move about freely and rest comfortably. Attaching and removing the device was easy and quick and it remained in place for up to 120 hours without the need to reposition it. CONCLUSION: The modified craniocervical isolation collar made it possible to conduct the experiment with isolation of the rabbits' ears, ease of handling, and without causing limitations in relation to the animals' ability to eat and move about freely.

OBJETIVO: Avaliar um colar de isolamento crânio-cervical, para uso em coelhos, quanto aos seguintes aspectos: eficácia da fixação crânio-cervical em até 120 h; facilidade de manuseio; liberdade do animal para deambular e ingerir alimentos; integridade física do animal durante e depois do uso do dispositivo. MÉTODOS: A partir do colar elizabetano confeccionou-se um colar de isolamento crânio-cervical para uso em coelhos, com as seguintes modificações: amplo corte no aparelho, em forma de meia lua, coincidindo com a boca do animal; divisão interna do dispositivo em dois compartimentos, para isolar e imobilizar as orelhas, individualmente; perfurações múltiplas no compartimento superior para melhor ventilação; adaptação de correia cérvico-torácica, para fixar o colar na região cervical, mantendo-se as presilhas de fechamento no dorso do animal. O dispositivo foi utilizado em 18 coelhos machos da raça Nova Zelândia, por período de até 120 horas consecutivas. RESULTADOS: O aparelho foi eficaz no isolamento crânio-cervical e das orelhas de coelhos, não interferiu nas funções respiratórias do animal, na deglutição de alimentos e não causou trauma físico, permitindo a livre deambulação e conforto no repouso. Foi de fácil e rápido manuseio na colocação e retirada, permanecendo no local sem necessidade de reposicionamento por até 120 horas. CONCLUSÃO: O colar de isolamento crânio-cervical modificado possibilitou a realização do experimento com isolamento das orelhas dos coelhos, com facilidade no manuseio, sem causar limitações ao animal em relação à ingestão de alimentos e deambulação.

Recidiva local nos sarcomas de tecidos moles: fatores prognósticos / Local recurrence in soft tissue sarcoma: prognostic factors

OBJETIVO: Determinar os fatores prognósticos associados com a recorrência local nos pacientes submetidos a tratamento de sarcoma de tecidos moles em extremidades. MÉTODOS: Foram avaliados retrospectivamente 30 pacientes tratados por ressecção cirúrgica de sarcoma de tecidos moles localizados em extremidades, com seguimento 36,5 ± 12,2 meses. Foram avaliados como fatores prognósticos: idade, sexo, localização, profundidade, localização em compartimentos anatômicos, tamanho, manipulação prévia ao tratamento definitivo, margens cirúrgicas, grau de malignidade histológica, presença de necrose e invasão vascular à histologia. Estes fatores foram correlacionados com a ocorrência de recidiva local do tumor por uma análise univariada e multivariada, sendo considerados significativos valores de p = 0,05. RESULTADOS: A recorrência local apresentou correlação significativa, tanto na análise univariada como multivariada, com a localização extra-compartimental (p = 0,001) e com o alto grau de malignidade (p = 0,024). Não houve associação com a idade (p = 1,000), com o sexo (p = 1,000), com a localização em segmentos corporais (p = 0,544), com a profundidade (p = 0,288), com o tamanho (p = 0,694), com as margens cirúrgicas (p = 0,384), com a manipulação prévia (p = 0,461), com a presença de necrose (p = 0,461) ou invasão vascular (p = 1,000). CONCLUSÃO: A recorrência local apresentou correlação com a localização extra-compartimental e com o alto grau de malignidade dos tumores.

OBJECTIVE: To determinate the prognostic factors associated with the local relapse in patients treated for soft tissue sarcoma in extremities. METHODS: Retrospectively, 30 patients were evaluated after being treated with surgical resection of soft tissue sarcoma located in extremities, with a outcome of 36,5 ± 12,2 months. The prognostic factors evaluated were: age, sex, location, depth, location in the anatomic compartments, size, tumor previous manipulation, surgical margins, grade of histological malignance, presence of histological necrosis or histological vascular invasion. These factors were correlated with the local relapse of the tumor with a univariated and multivariated analysis with significance when p = 0,05. RESULTS: Local relapse presented significant correlaction in univariated and multivariated analysis with extra-compartimental location (p = 0,001) and with high grade histological malignance (p = 0,001). There was no significant association with age (p = 1,000), sex (p = 1,000), body location (p = 0,544), depth (p = 0,288), size (p = 0,694), surgical margins (p = 0,384), previous manipulation (p = 0,461), necrosis (p = 0,461) or with the presence of vascular invasion (p = 1,000). CONCLUSION: Local relapse presents correlaction with extra-compartimental location and with high grade malignancy tumors.

Efeito da colestase nos aspectos funcionais e morfológicos renais após nefrectomia / Effect of cholestasis on renal morphological and functional aspects after nephrectomy

OBJETIVOS: O crescimento de um rim em resposta à perda do outro rim recebe o nome de hipertrofia renal compensatória. Entretanto, os mecanismos que regulam esse processo ainda não foram esclarecidos. Neste estudo, avaliaram-se os efeitos da icterícia obstrutiva na morfologia e na função do rim remanescente após nefrectomia unilateral. MÉTODOS: Foram estudados 40 ratos Wistar (250g-300 g), distribuídos nos seguintes grupos: Grupo 1 - operação simulada; Grupo 2 - nefrectomia direita; Grupo 3 - ligadura do ducto biliar; Grupo 4 - ligadura do ducto biliar e nefrectomia direita. Os animais foram mortos após 20 dias, quando foi colhido sangue para exames laboratoriais e feita a retirada dos rins e do fígado. Os rins foram pesados para avaliação do crescimento compensatório. Rins e fígado foram estudados histologicamente por microscopia óptica. RESULTADOS: Não houve diferença no aumento do peso renal relativo entre os animais dos Grupos 2 e 4 (p = 0,4). Os animais submetidos à ligadura do ducto biliar isoladamente (Grupo 3) apresentaram maior peso renal relativo quando comparados com os animais submetidos à operação simulada (Grupo 1) (p = 0,011). As alterações histológicas encontradas foram dilatação capilar da camada medular nos rins hipertrofiados e modificações típicas de colestase nos fígados dos animais ictéricos. Cirrose foi encontrada apenas nos animais submetidos à nefrectomia. CONCLUSÃO: O peso e a função do rim remanescente após nefrectomia unilateral não são afetados pela icterícia obstrutiva.

OBJECTIVE: The removal of one kidney results in a compensatory growth of the remnant kidney. However, the mechanism that underlies this hypertrophic response is not understood. In this study we assessed the influence of obstructive jaundice on renal morphology and function after unilateral nephrectomy. METHODS: Forty Wistar rats (250-300 g) were randomly divided into four groups: Group 1 - sham operation, Group 2 - right nephrectomy, Group 3 - common bile duct ligation, Group 4 - common bile duct ligation and right nephrectomy. After 20 days, blood was collected for biochemical studies and the animals were killed. Their kidneys and livers were removed and weighed. Histological evaluation of both organs was carried out. RESULTS: No difference in the kidney/body weight ratio was observed for animals undergoing right nephrectomy (Groups 2 and 4) (p = 0.4). Animals submitted to bile duct ligation only (Group 3) presented a higher kidney/body weight ratio than animals submitted to sham operation (Group 1) (p = 0.011). Vasodilatation was identified in the medulla of the hypertrophied kidneys and histological alterations were found in the livers of the jaundiced animals. Cirrhosis occurred only in nephrectomized rats. CONCLUSION: Cholestasis does not affect the weight, function or the compensatory renal growth of the remnant kidney after unilateral nephrectomy.

Fatores prognósticos para o desenvolvimento de metástases nos sarcomas de tecidos moles / Prognosis factors in the development of metastases in soft tissue sarcomas

OBJETIVO: Determinar os fatores prognósticos relacionados com o desenvolvimento de metástases a distância nos pacientes com diagnóstico de sarcoma de tecidos moles (STM) em extremidades. MÉTODOS: Foram avaliados 30 pacientes tratados por ressecção cirúrgica de STM, com seguimento médio de 36,5 ± 12,2 meses, utilizando como fatores prognósticos: idade, sexo, localização, profundidade, localização em compartimentos anatômicos, tamanho, manipulação prévia ao tratamento definitivo, margens cirúrgicas, grau de malignidade histológica, presença de necrose e invasão vascular à histologia. Esses fatores foram correlacionados com o desenvolvimento de metástases por análise univariada e multivariada, sendo considerados significativos valores de p < 0,05. RESULTADOS: Na análise univariada houve correlação do desenvolvimento de metástases com a localização extracompartimental (p = 0,002), com o tamanho > 10cm (p = 0,007), com o alto grau de malignidade (p = 0,007), com a presença de necrose (p = 0,002) e com a presença de invasão vascular (p = 0,034). A idade (p = 1,000), o sexo (0,709), a localização em segmentos corporais (p = 0,298), a profundidade (p = 0,288), a margem cirúrgica (p = 0,419) e a manipulação prévia do tumor (p = 1,000) não apresentaram correlação com a ocorrência de metástases a distância. Na análise multivariada apenas a localização extracompartimental (p = 0,008), o tamanho (p = 0,018) e a presença de invasão vascular (p = 0,043) foram significativos. CONCLUSÃO: O desenvolvimento de metástases a distância nos pacientes com sarcoma de tecidos moles depende da localização extracompartimental, do tamanho (> 10cm), do alto grau de malignidade histológica, da presença de necrose e da invasão vascular à histologia.

OBJECTIVE: To determine the prognostic factors related to the development of remote metastases in patients with the diagnosis of soft tissue sarcoma (STS) in the extremities. METHODS: 30 patients treated with surgical resection of STS with a mean follow-up of 36.5 ± 12.2 months were evaluated using the following prognosis factors: age, gender, location, depth, location in anatomic compartments, size, handling before final treatment, surgical borders, degree of histological malignancy, presence of necrosis, and histologically-verified vascular invasion. Such factors were correlated to the development of metastases by univariate analysis, values of p < 0.05 being considered significant. RESULTS: The univariate analysis showed a correlation of the development of metastases and the extra-compartmental location (p = 0.002), size > 10 cm (p = 0.007), the high degree of malignancy (p = 0.007), the presence of necrosis (p = 0.002) and the presence of vascular invasion (p = 0.034). Age (p = 1.000), gender (0.709), location in body segments (p = 0.298), depth (p = 0,288), surgical border (p = 0.419), and prior handling of the tumor (p = 1.000) did not show a correlation with the occurrence of remote metastases. In the multivariate analysis, only the extra-compartmental location (p = 0.008), size (p = 0.018), and the presence of vascular invasion (p = 0.043) were significant. CONCLUSION: The development of remote metastases in patients with soft tissue sarcoma depends on the extra-compartmental location, on the size (> 10 cm), on the high degree of malignancy seen in histology, on the presence of necrosis, and on vascular invasion seen in histology.

Caso para diagnóstico / Case for diagnosis

É relatado caso de elastólise da derme média em paciente do sexo feminino, de 37 anos, que apresentava áreas de enrugamento fino da pele, principalmente nas flexuras e pápulas perifoliculares com aspecto em peau d´orange na região paravertebral, conferindolhe aspecto precocemente envelhecido. A histologia mostrava fragmentação e rarefação das fibras elásticas restritas à porção média da derme.

A case of mid-dermal elastolysis is reported in a 37-year-old female patient, who presented skin areas with fine wrinkles, mainly in fold areas and also perifollicular papules similar to peau d'orange in the paravertebral area, lending her a prematurely elderly appearance. Histological examination revealed fragmentation and rarefaction of elastic fibers, restricted to the mid-dermis portion.