Neoplasia intraepitelial escamosa cervical de alto grau: abordagem ambulatorial / High-grade cervical intraepithelial neoplasia: outpatient approach

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

Neoplasia intraepitelial escamosa cervical: abordagem por estimativas de risco / Cervical squamous intraepithelial neoplasia: risk estimation approach

As neoplasias intraepiteliais cervicais representam a fase pré-tumoral da neoplasia invasiva do colo uterino; são identificadas por citologia e testes de DNA-HPV e conduzidas por intervenções ambulatoriais. A perspectiva de estimativas de risco, para abordagem de tais lesões, constitui uma verdadeira mudança de paradigma, tendo em vista que as recomendações serão baseadas em riscos, não em resultados.(AU)

Cervical intraepithelial neoplasms represent the pre-tumor phase of invasive cervical cancer; identified by cytology, HPV-DNA testing and conducted by outpatient interventions. The perspective of risk estimates, to address such injuries, constitutes a true paradigm shift, considering that recomendations will be based on risks, not results.(AU)

Histerectomia radical após parto cesáreo por adenocarcinoma de colo uterino: relato de caso / Radical hysterectomy after c-section in cervical adenocarcinoma: a case report

Mundialmente, o câncer de colo uterino ocupa o quarto lugar das neoplasias em mulheres, porém, nos países em desenvolvimento, as taxas de incidência superam de forma impactante os casos de países desenvolvidos. Apesar de ser um evento incomum durante a gestação, é cada vez mais observado, o que talvez possa ser atribuído às gestações programadas em idades mais avançadas. O caso descrito refere-se a uma paciente de 32 anos de idade, diagnosticada no terceiro trimestre da gestação com adenocarcinoma de origem endocervical com estadiamento anatomopatológico final (FIGO 2018) 1B2. Ela foi submetida à abordagem cirúrgica como tratamento inicial. Foi adotada como conduta a resolução da gestação, com boa vitalidade fetal, ao final da 34ª semana, após corticoterapia para maturação pulmonar fetal. Foi realizado parto cesariano seguido de histerectomia radical tipo C1 na classificação de Querleu e Morrow associado a linfadenectomia pélvica, no mesmo ato operatório.(AU)

Worldwide, cervical cancer ranks fourth in female cancers, but when assessing data from developing countries, incidence rates are significantly higher than in developed countries. Although it is an uncommon event during pregnancy, it is increasingly observed, which may perhaps be justified due to pregnancies postponed at older ages. The case described relates to a 32-year-old woman diagnosed in the third trimester of pregnancy with endocervical adenocarcinoma, whose final anatomopathological staging (FIGO 2018) was IB2. The same was submitted to the surgical approach as an initial treatment. It was adopted as a conduct, the resolution of pregnancy, with good fetal viability, at the end of the 34th week, after corticosteroid therapy for fetal lung maturation. The patient underwent cesarean section followed by radical type C1 hysterectomy in the classification of Querleu and Morrow associated with pelvic lymphadenectomy in the same surgery.(AU)

Exercício Físico Melhora as Funções das Células Progenitoras Endoteliais em Pacientes com Síndrome Metabólica / Exercise Training Improves Functions of Endothelial Progenitor Cells in Patients with Metabolic Syndrome

Resumo Fundamento As células progenitoras endoteliais (CPEs) desempenham um papel importante na manutenção da função endotelial. A síndrome metabólica (SM) está associada à disfunção das CPEs. Embora o exercício físico tenha um impacto benéfico na atividade das CPEs, seu mecanismo ainda não está completamente esclarecido. Objetivo O objetivo deste estudo é investigar os efeitos do exercício físico nas funções das CPEs e os mecanismos subjacentes em pacientes com SM. Métodos Os voluntários com SM foram divididos em grupo exercício (n=15) e grupo controle (n=15). Antes e após 8 semanas de treinamento físico, as CPEs foram isoladas do sangue periférico. Foram feitos o ensaio de unidades formadoras de colônias (UFC), o ensaio de formação de tubos, a expressão proteica do óxido nítrico sintase endotelial (eNOS), da fosfatidilinositol-3-quinase (PI3-K) e da proteína quinase B (AKT). Considerou-se um valor de probabilidade <0,05 para indicar significância estatística. Resultados Após 8 semanas, o número de UFCs aumentou significativamente no grupo exercício em comparação com o grupo controle (p<0,05). Além disso, observamos uma diminuição significativa do modelo de avaliação da homeostase da resistência à insulina (HOMA-IR), endotelina-1, proteína C reativa de alta sensibilidade e dos níveis de homocisteína no grupo exercício. A intervenção com exercícios também pode aumentar a capacidade de formação de tubos de CPEs e aumentar o nível de fosforilação de eNOS, PI3-K e AKT. Conclusão O exercício físico aprimorou as funções das CPEs. O mecanismo pode estar relacionado ao exercício, ativando a via PI3-K/AKT/eNOS.

Abstract Background Endothelial progenitor cells (EPCs) play an important role in maintaining endothelial function. Metabolic syndrome (MetS) is associated with EPC dysfunction. Although physical exercise has a beneficial impact on EPC activity, its mechanism is not completely clear yet. Objective The purpose of this study is to investigate the effects of physical exercise on the functions of EPCs and the underlying mechanisms in patients with MetS. Methods Volunteers with MetS were divided into exercise group (n=15) and control group (n=15). Before and after 8 weeks exercise training, EPCs were isolated from peripheral blood. Colony forming unit (CFU) assay, tube-formation assay, the protein expression of endothelial nitric oxide synthase (eNOS), phosphatidylinositol-3-kinase (PI3-K) and protein kinase B (AKT) were determined. A probability value <0.05 was considered to indicate statistical significance. Results After 8 weeks, the number of CFUs was significantly increased in the exercise group compared to the control group (p<0.05). In addition, we observed a significant decrease of homeostasis model assessment for insulin resistance (HOMA-IR), endothelin-1, high-sensitive C-reactive protein, and homocysteine levels in the exercise group. Exercise intervention could also enhance tube-formation capacity of EPCs and increase phosphorylation level of eNOS, PI3-K and AKT. Conclusion Physical exercise enhanced the functions of EPCs. The mechanism may be related to exercise, activating the PI3-K/AKT/eNOS pathway.

Resultado de los medios diagnósticos en pacientes operados de cáncer de tiroides. Hospital Universitario Comandante "Faustino Pérez Hernández". Matanzas / Outcomes of the diagnostic means in patients undergoing thyroid cancer surgery. University Hospital "Comandante Faustino Pérez Hernández". Matanzas

RESUMEN Introducción: el cáncer de tiroides representa un 1% del total de todos los tipos de cáncer. Su incidencia parece aumentar un 4% cada año, y en la actualidad es el octavo cáncer más frecuente en mujeres. Se utilizan medios diagnósticos para definir que paciente operar y la estrategia terapéutica a seguir. Objetivo: evaluar el resultado de los medios diagnósticos en los pacientes operados de cáncer de tiroides. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo y observacional que incluye todos los pacientes operados de cáncer tiroides en el servicio de Cirugía General del Hospital Universitario "Comandante Faustino Pérez Hernández", en el período desde enero de 1993 a diciembre del 2018. Se confeccionó una planilla pararecopilar la información para el estudio de la base de datos y los resultados se presentaron en tablas de frecuencia, números y porciento. Resultados: el cáncer de tiroides fue más frecuente en el grupo etario de 31 a 50 años, predomino el sexo femenino, la variedad histológica papilar fue la más frecuente, el ultrasonido y la citología con aguja fina aportan resultados favorables para definir la estirpe biológica de los tumores del tiroides, no comportándose de igual forma la biopsia por congelación. Conclusiones: el cáncer de tiroides es más frecuente en pacientes relativamente jóvenes, del sexo femenino y de variedad papilar. El ultrasonido y la citología con aguja fina aportan criterios beneficiosos para definir conducta terapéutica (AU).

SUMMARY Introduction: thyroid cancer represents 1% of the total of all kinds of cancer. Its incidence seems to increase 4% every year, and at the present time it is the eighth more frequent cancer in women. Diagnostic means are used to determine what patient undergoes a surgery and the therapeutic strategy to follow. Objective: to evaluate the results of the diagnostic means used in patients who undergo a thyroid cancer surgery. Materials and methods: a retrospective, descriptive, observational study was carried out including all patients who underwent a surgery of thyroid cancer in the service of General Surgery of the University Hospital ¨Comandante Faustino Perez Hernandez¨ in the period from January 1993 to December 2018. A form was elaborated to collect the information for the study of the database; the results were presented in charts of frequency, numbers and percentages. Results: the thyroid cancer was more frequent in the age group of 31 to 50 years; the female sex prevailed; the most frequent variety was the histological papillary one; ultrasound and fine needle cytology yield favourable results to define the biological stock of the thyroid cancers unlike the behaviour of the biopsy by freezing. Conclusions: thyroid cancer of the papillary variety is more frequent in relatively young, female patients. Ultrasound and fine needle cytology yield beneficial criteria to define the therapeutic behaviour (AU).

Prevalencia de diagnósticos de enfermería en el programa de detección temprana de cáncer de cérvix / Prevalence of nursing diagnoses in the early cervical cancer detection program

Resumen Introducción: El cáncer de cérvix representa un problema de salud pública a nivel mundial, al constituirse en la tercera causa de mortalidad por neoplasias malignas en la mujer. Objetivo: Determinar la prevalencia de los diagnósticos de enfermería en usuarias del programa de detección temprana de cáncer de cérvix, en una institución de salud de primer nivel de atención del municipio de Girón, Santander. Materiales y métodos: Estudio de corte transversal. La muestra estuvo conformada por 85 usuarias atendidas por estudiantes tercer nivel de enfermería durante la práctica de Cuidado de la Salud de la Mujer. Se realizó valoración focalizada del estado de salud a partir del Formato de Valoración de la Escuela de Enfermería de la Universidad Industrial de Santander; e información registrada en el Sistema de Información de Prácticas Clínicas y Comunitarias Estudiantiles (SIPCE). Resultados: Los diagnósticos de mayor prevalencia fueron Disposición para mejorar los conocimientos con un 35,29%, Conocimientos deficientes con el 32,29% y Disposición para mejorar el autocuidado con 20,00%. Entre los de menor prevalencia se encuentran mantenimiento ineficaz de la salud en un 2,35%, Temor y Riesgo de infección con 4,71% cada uno. Conclusión: La identificación de los diagnósticos más frecuentes en usuarias del programa de detección temprana de cáncer de cérvix, es una propuesta para que estudiantes y profesionales de enfermería lleven a cabo planes de cuidado, mediante el uso del lenguaje estandarizado en el ejercicio de la práctica de enfermería.

Abstract Introduction: Cervical cancer represents a public health problem worldwide, as it is the second leading cause of mortality due to malignant neoplasms in women. Objetive: To determine the prevalence of nursing diagnoses in users of the cervical cancer early detection program, in a first level health care institution in the municipality of Girón, Santander. Materials and methods: Cross section study. The sample consisted of 85 users attended by third level nursing students during the practice of Women's Health Care. A focused assessment of the state of health was carried out using the Valuation Form of the Nursing School of the Universidad Industrial de Santander, and information registered in the Information System of Clinical and Community Student Practices (SIPCE). Results: The most prevalent diagnoses were Disposition to improve knowledge with 35.29%, deficient knowledge with 32.29% and willingness to improve self-care with 20.00%. Among the lowest prevalence are Ineffective maintenance of health at 2.35%, Fear and Risk of infection with 4.71% each. Conclusion: The identification of the most frequent diagnoses in users of the cervical cancer early detection program is a proposal for students and nursing professionals to carry out care plans, through the use of standardized language in the exercise of nursing practice.

Tratamiento quirúrgico del Bocio Coloide en el Hospital Regional de Huambo, Angola / Colloid Goiter Surgical treatment in Huambo Regional Hospital, Angola

RESUMEN Introducción: el Bocio Coloide es una causa frecuente de atención en las consultas externas de los servicios de salud en Angola. Por ello, es importante conocer sus formas fundamentales de presentación, los exámenes complementarios necesarios para su diagnóstico y el seguimiento establecido para vigilar su evolución. Objetivo: caracterizar el Bocio Coloide en pacientes operados por esta afección, en el Servicio de Cirugía General del Hospital Regional de Huambo, Angola. Métodos: se realizó un estudio prospectivo y transversal en pacientes con Bocio Coloide, operados en el Servicio de Cirugía General del Hospital Regional de Huambo, Angola. El universo estuvo constituido por 434 pacientes que acudieron a consulta desde enero 2013 a enero 2018. De dicho grupo, se obtuvo la muestra de 253 pacientes que padecían Bocio Coloide. Resultados: el sexo femenino predominó (89,8%), así como las edades entre 40 y 50 años (58,5%). Como comorbilidad se manifestó la hipertensión arterial (25,7%), asociada a la procedencia rural (65,2%). En nuestros pacientes, según el punto de vista clínico, el Bocio Coloide grado III (69,1%) y el simétrico (80,6%) fueron los más encontrados. La ecografía tiroidea resultó el método de estudio morfológico más sensible, mediante el cual corroboramos una mayor prevalencia del Bocio Coloide simétrico, hipoecoico, sin nódulos asociados y con calcificaciones. En este estudio, la Citología aspirativa con aguja fina es el método citológico de elección, donde la presencia moderada de coloide con células grandes y poligonales en pequeños grupos se incrementó. En el diagnóstico histológico de la glándula extirpada predominaron los folículos tiroideos grandes con distención, y epitelio cúbico alto con calcificaciones. Conclusiones: la tiroidectomía subtotal fue la resección quirúrgica que más se realizó; la complicación más evidente resultó la disfonía transitoria, y como secuela los queloides de la herida quirúrgica.

ABSTRACT Introduction: Colloid Goiter appears frecuently in outpatient health services in Angola. For this reason, it is important to know all its presentation features, for further examination, diagnosis and monitoring. Objective: to characterize Colloid Goiter behavior after surgery, at General Surgery Service of Huambo Regional Hospital of Angola. Methods: a transversal, prospective and descriptive study of Colloid Goiter patients, at General Surgery Service of Huambo Regional Hospital, Angola. Universe involved 434 patients and the sample was represented by 253 patients from this group. Results: females (89.8%), countryside patients (65.2%) as well as ages from 40 to 50 (58.5%) predominated. Hypertension prevailed over associated diseases (25.7%). From the clinical point of view, simetric (80.6%) and Colloid Goiter III (69.1%) were the most representatives. In all patients, Simetric and hipoecoic Colloid Goiter diagnosis were confirmed through echography. Associated nodules with calcifications were the most frequent. In this study, fine needle aspiration citology was the citological method of election from which coloid moderated presence with poligonals and big cells in little groups, extirpated gland histological diagnosis of big thyroid folicle with distention and high cubic epitele calcifications, prevailed. Conclusions: the Subtotal Thyroidectomy was the most frequent resection. The most obvious complication in thyroid surgery was transient dysphonia, as keloids sequelae from the surgical wound.

Assessment of the Relationship between Monocyte to High-Density Lipoprotein Ratio and Myocardial Bridge / Avaliação da Relação entre a Razão de Monócitos para Lipoproteínas de Alta Densidade e a Ponte Miocárdica

Abstract Background: Assessing the monocyte to high-density lipoprotein ratio (MHR) is a new tool for predicting inflamation, which plays a major role in atherosclerosis. Myocardial bridge (MB) is thought to be a benign condition with development of atherosclerosis, particularly at the proximal segment of the brigde. Objective: To evaluate the relationhip between MHR and the presence of MB. Methods: We consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary artery were enrolled in the study. The patients' angiographic, demographic and clinic characteristics of the patients were reviewed from medical records. Monocytes and HDL-cholesterols were measured via complete blood count. MHR was calculated as the ratio of the absolute monocyte count to the HDL-cholesterol value. MHR values were divided into three tertiles as follows: lower (8.25 ± 1.61), moderate (13.11 ± 1.46), and higher (21.21 ± 4.30) tertile. A p-value of < 0.05 was considered significant. Results: MHR was significantly higher in the MB group compared to the control group with normal coronary arteries. We found the frequency of MB (p = 0.002) to increase as the MHR tertiles rose. The Monocyte-HDL ratio with a cut-point of 13.35 had 59% sensitivity and 65.0% specificity (ROC area under curve: 0.687, 95% CI: 0.606-0.769, p < 0.001) in accurately predicting a MB diagnosis. In the multivariate analysis, MHR (p = 0.013) was found to be a significant independent predictor of the presence of MB, after adjusting for other risk factors. Conclusion: The present study revealed a significant correlation between MHR and MB.

Resumo Fundamento: A avaliação da razão de monócitos para lipoproteínas de alta densidade (MHR, sigla em inglês) é uma nova ferramenta para se prever o processo inflamatório, o qual desempenha um papel importante na aterosclerose. A ponte miocárdica (PM) é considerada uma condição benigna com desenvolvimento de arteriosclerose, particularmente no segmento proximal da ponte. Objetivo: Avaliar a relação entre a MHR e a presença de PM. Métodos: Examinamos concecutivamente pacientes encaminhados para angiografia coronariana entre janeiro de 2013 e dezembro de 2016, e um total de 160 pacientes, uma parcela dos quais com PM, e outra com artérias coronárias normais, foram incluídos no estudo. As características angiográficas, demográficas e clínicas dos pacientes foram revisadas a partir de registros médicos. Monócitos e colesteróis HDL foram medidos através de hemograma completo. A MHR foi calculada como a razão entre a contagem absoluta de monócitos e o valor do colesterol HDL. Os valores de MHR foram divididos em três tercis, da seguinte forma: tercil inferior (8,25 ± 1,61); tercil moderado (13,11 ± 1,46); e tercil superior (21,21 ± 4,30). Considerou-se significativo um valor de p < 0,05. Resultados: A MHR foi significativamente maior no grupo com PM, em comparação com grupo controle com artérias coronárias normais. Verificamos que a prevalência de PM (p=0,002) aumentou à medida que se elevavam os tercis de MHR. A razão monócitos-colesterol HDL com ponto de corte de 13,35 apresentou sensibilidade de 59% e especificidade de 65,0% (área ROC sob a curva: 0,687, IC95%: 0,606-0,769, p < 0,001) na predição acurada do diagnóstico de PM. Na análise multivariada, a MHR (p = 0,013) mostrou-se um preditor independente significativo da presença de PM, após ajustes para outros fatores de risco. Conclusão: O presente estudo revelou uma correlação significativa entre MHR e PM.

Infección por VPH y su correlación clínica en población indígena de la región altoandina del Ecuador / Infección por VPH y su correlación clínica en población indígena de la región altoandina del Ecuador VPH infection and its clinical correlation in indigenous population of the high andean region of Ecuador

El cáncer cervico-uterino (CaCu) constituye un problema de salud pública. Estudios epidemiológicos han identificado una estrecha relación entre el CaCu y la infección por el virus del papiloma humano (VPH). El objetivo del estudio fue realizar la detección molecular de VPH, identificación de infecciones mixtas y el tamizaje de CaCu a través de un estudio transversal a 189 mujeres entre 21 a 65 años pertenecientes a la comunidad de Pilahuin- Provincia del Tungurahua a las cuales se les realizó detección molecular de VPH y citología convencional. Los resultados fueron analizados con los programas EPI INFO y SPSS. Resultados: La edad promedio de las participantes fue de 35,2 años, en relación estable, multíparas, con un nivel medio, bajo de instrucción, sin trabajo remunerado. El 100% de las participantes presentó una actitud favorable frente a la citología cervico-uterina sin mostrar relación con la edad, nivel de instrucción o estado civil. El 10,5% de las participantes presentaron infección por VPH y un 70% de las pacientes presentaron inflamación severa con una asociación positiva a infección bacteriana mixta.

Cervical-uterine cancer (CaCu) is a public health problem. Epidemiological studies have identified a close relationship between CaCu and human papillomavirus (HPV) infection. The purpose of this study was to perform the molecular detection of HPV, identification of mixed infections and the screening of CaCu through conventional cytology in an indigenous population of the high Andean highlands of Ecuador in order to correlate the data obtained with the presence of lesions. Methodology: A cross-sectional study was carried out on 189 women between the ages of 21 and 65; who belonged to the community of Pilahuin in the province of Tungurahua, who assisted to gynecological check-ups. Data were analyzed with the EPI-INFO and SPSS statistical programs. Results: the average age of the participants was 35.2 years, most of the participants identified themselves as indigenous, in a stable relationship, multiparous, with a medium to low level of education and no paid work. The participants showed a favorable attitude towards the cervico-uterine cytology in 100% of the cases without showing a relation with age, level of education or civil status. HPV infection was positive in 10.5% of the participants, 70% of the patients had severe inflammation with a positive association with mixed bacterial infection.

The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients

ABSTRACT Objective Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses. Material and Methods Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined. Results Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%), followed by Warthin’s tumor (17.5%). The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV) was 73% and negative predictive value (NPV) was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue. Conclusion FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy.

Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1, 000 nodules / Correlação entre a classificação Thyroid Imaging Reporting and Data System [TI-RADS] e punção aspirativa por agulha fina: experiência com 1. 000 nódulos

ABSTRACT Objective To correlate the Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda system in reporting cytopathology in 1,000 thyroid nodules. Methods A retrospective study conducted from November 2011 to February 2014 that evaluated 1,000 thyroid nodules of 906 patients who underwent ultrasound exam and fine needle aspiration. Results A significant association was found between the TI-RADS outcome and Bethesda classification (p<0.001). Most individuals with TI-RADS 2 or 3 had Bethesda 2 result (95.5% and 92.5%, respectively). Among those classified as TI-RADS 4C and 5, most presented Bethesda 6 (68.2% and 91.3%, respectively; p<0.001). The proportion of malignancies among TI-RADS 2 was 0.8%, and TI-RADS 3 was 1.7%. Among those classified as TI-RADS 4A, proportion of malignancies was 16.0%, 43.2% in 4B, 72.7% in 4C and 91.3% among TI-RADS 5 (p<0.001), showing clear association between TI-RADS and biopsy results. Conclusion The TI-RADS is appropriate to assess thyroid nodules and avoid unnecessary fine needle aspiration, as well as to assist in making decision about when this procedure should be performed.

RESUMO Objetivo Apresentar a correlação entre o Thyroid Imaging Reporting and Data System (TI-RADS) e o sistema Bethesda, para relatar citopatologia em 1.000 nódulos tireoidianos. Métodos Estudo retrospectivo realizado no período de novembro de 2011 a fevereiro de 2014, que avaliou 1.000 nódulos tireoidianos de 906 pacientes submetidos a exame de ultrassonografia e à punção aspirativa por agulha fina. Resultados Observou-se associação significativa entre o TI-RADS e o resultado da classificação de Bethesda (p<0,001). A maioria dos indivíduos com TI-RADS 2 ou 3 teve resultado citológico Bethesda 2 (95,5% e 92,5%, respectivamente). Entre aqueles classificados TI-RADS 4C e 5, a maioria teve resultado Bethesda 6 (68,2% e 91,3%, respectivamente; p<0,001). A proporção de malignidades em TI-RADS 2 foi 0,8% e em TI-RADS 3 foi 1,7%. Entre TI-RADS 4A, foi de 16,0%, 43,2% em 4B, 72,7% em 4C e em 5 foi de 91,3% (p<0,001), mostrando clara associação entre o TI-RADS e os resultados da biópsia. Conclusão O TI-RADS é apropriado para avaliar nódulos da tireoide e evitar punção aspirativa por agulha fina desnecessária, além de auxiliar na decisão sobre quando este procedimento deve ser realizado.

Prevalência da lesão HPV induzida em canal anal de mulheres com neoplasia intraepitelial cervical 2 e 3: um estudo de corte transversal / Prevalence of HPV-induced lesions in the anal canal among women with cervical intraepithelial neoplasia 2 and 3: cross-sectional study

OBJETIVO: Determinar a prevalência da lesão anal induzida por HPV em mulheres com neoplasia intraepitelial cervical grau 2/3 (NIC2/3).MÉTODOS: Estudo transversal, realizado no período de dezembro de 2008 a junho de 2009, no Estado de Pernambuco, nordeste do Brasil. Foram incluídas no estudo apenas mulheres com diagnóstico de NIC2/3 confirmado por biópsia e excluídas aquelas que não realizaram exame na primeira visita. As amostras para identificação do DNA de HPV anal por PCR e citologia anal foram coletadas com escovinha endocervical. A biópsia anal foi realizada nos casos de citologia anal anormal ou alterações maiores na anuscopia de alta resolução (AAR).RESULTADOS: Das AARs, 32,1% (n=37/115) foram normais e 63,5% (n=73/115) exibiram epitélio acetobranco. Vinte e dois por cento das citologias anais (n=26/115) foram anormais. Dentre elas, 12,2% (14/26) corresponderam à lesão intraepitelial anal de baixo grau e 3,4% (n=4/26), a lesão intraepitelial anal de alto grau. Foram realizadas 22 biópsias, das quais 13,7% (n=3/22) tiveram diagnóstico de neoplasia intraepitelial anal (NIA2) e 9% (n=2/22), NIA 3. Identificou-se 72,1% (n=83/115) de DNA do HPV nas amostras.CONCLUSÃO: Mulheres com NIC2/3 apresentam elevada prevalência de infecção por HPV e lesão HPV induzida em canal anal.

PURPOSE: To determine the prevalence of HPV-induced lesions in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade 2/3.METHODS: A cross-sectional study was carried out from December 2008 to June 2009, in Pernambuco, northeastern Brazil. Only women with grade 2/3 CIN were included, and those who could not undergo anoscopy during their first visit were excluded. A cyttobrush was used for sample collection in order to identify HPV DNA through PCR and anal cytology. An anal biopsy was obtained in cases of abnormal anal cytology or major alterations in high resolution anoscopy (HRA).RESULTS: Thirty-two percent (n=37/115) of HRA were normal and 63.5% (n=73/115) showed acetowhite epithelium. Twenty-two percent (n=26/115) of anal cytologies were abnormal. Among the latter, 12.2% (n=14/26) were low-grade anal intraepithelial lesions and 3.4% (n=4/26) were high-grade anal intraepithelial lesions. Twenty-two anal biopsies were performed, 13.7% of which (n=3/22) were grade 2 anal intraepithelial neoplasia (AIN2) and 9% (n=2/22) were grade 3 AIN. Th HPV DNA was identified in 72.1% of cases (n=83/115).CONCLUSION: Women with CIN grade 2/3 showed a high prevalence of anal HPV infection and HPV-induced lesions.

Características clínicas, ultrasonográficas y anatomopatológicas de pacientes operados por sospecha de malignidad tiroidea / Clinical, ultrasonographic and anatomopathological characteristics of patients operated on for suspected thyroid malignancy

Introducción: El carcinoma tiroideo se caracteriza por su lenta evolución y elevado porcentaje de curación. Objetivo: describir las características clínicas, ultrasonográficas y anatomopatológicas de los pacientes operados. Métodos: estudio descriptivo, retrospectivo. Se utilizaron para obtener el dato primario las historias clínicas de los pacientes que cumplieron con los criterios de inclusión: operados por sospecha de malignidad tiroidea, mayores de 18 años de edad que contaron con datos completos demográficos, clínicos, sonográficos y anatomopatológicos, y que estuviesen inscritos en el hospital. Se confeccionaron tablas de distribución de frecuencias. Se aplicó la prueba de comparación de proporciones para describir la significación estadística de las variables estudiadas en relación con la malignidad tiroidea. Resultados: el 81,8 por ciento de los pacientes afectados de malignidad tiroidea correspondió al género femenino. El 39,4 por ciento de estos correspondieron al grupo de edad entre 41 y 50 años, el 75,8 por ciento de este grupo de pacientes correspondió al examen sonográfico con un área del nódulo tiroideo mayor de 10 mm, el 53,3 por ciento de estos pacientes presentó como morfología tiroidea el nódulo único, y el 75,8 por ciento presentó como resultado de la citología con aguja fina un carcinoma de tiroides. El 91 por ciento presentó como clasificación histológica carcinoma papilar. Conclusiones: la mayor frecuencia de carcinoma fue la variante papilar. Se encontró de forma predominante en mujeres con edades entre los 41 y 50 años que tenían nódulos mayores de 1 cm(AU)

Introduction: Thyroid carcinoma is characterized by slow progression and high recovery percentage. Objective: to describe the clinical, ultrasonographic and anatomopathological characteristics of patients operated on for thyroid malignancy. Methods: retrospective and descriptive study for which the primary data were collected from the medical histories of patients who met the inclusion criteria. These criteria comprised surgery for suspected thyroid malignancy, age over 18 years, and complete demographic, clinical, ultrasonographic and anatomopathological data and registration at the hospital. Frequency distribution tables were drawn up. The ratio comparison test was applied to describe the statistical significance of the studied variables with respect to the thyroid malignancy. Results: in the group of patients with thyroid malignancy, 81.8 percent were females, 39.4 percent aged 41 to 50 years. The ultrasonographic test showed that 75.8 percent of them had a thyroid nodule area greater than 10 mm, 53.3 percent presented solitary nodule morphology whereas the result of the fine needle aspiration cytology was thyroid carcinoma. The histological classification yielded papillary carcinoma in 91 percent of patients. Conclusions: the papillary carcinoma was the most common, particularly in females aged 41 to 50 years who had over 1 cm nodules(AU)

Aplicabilidade da técnica de cell block na avaliação citológica do conteúdo de lesões de aspecto cístico dos maxilares / Applicability of cell block technique for cytological evaluation of biological material collected from maxillary cystic lesions

INTRODUÇÃO: A busca por novos métodos que auxiliem e simplifiquem de maneira eficaz o diagnóstico de lesões maxilares, cistos e tumores, objetiva beneficiar os pacientes e facilitar a atuação dos profissionais da área de diagnóstico bucal. Além dos dados clínicos, radiográficos e histopatológicos classicamente utilizados nos protocolos de investigação das lesões maxilares, a adaptação de técnicas já consagradas na medicina pode ser de grande valia. A técnica de cell block se propõe a auxiliar nesse processo, pois consiste na análise citológica de materiais, efusões e líquidos, coletados de lesões passíveis de punção aspirativa, como cistos e tumores císticos dos maxilares. OBJETIVO: Demonstrar a aplicabilidade da técnica de cell block para avaliação citológica de material biológico coletado a partir de lesões císticas dos maxilares. RESULTADOS: Das 20 lesões, das quais o conteúdo foi processado pela técnica, a avaliação citológica de cinco casos de tumores odontogênicos ceratocísticos (TOCs) demonstrou a presença predominante de ceratina, sempre com áreas de paraceratina. Nos demais casos (cinco cistos dentígeros, cinco cistos radiculares e cinco cistos residuais) foi observada a presença de hemácias, células inflamatórias e fendas de cristais de colesterol. CONCLUSÃO: A avaliação citológica, a partir da técnica de cell block, foi útil no estabelecimento do diagnóstico diferencial entre TOC e demais lesões estudadas, cistos radicular, residual e dentígero.

INTRODUCTION: The search for new methods that aid and optimize the diagnosis of cystic and tumoral maxillary lesions aims to benefit both patients and professionals from oral diagnosis. In addition to clinical, radiographic and histological findings traditionally used in research protocol for maxillary lesions, the adaptation of widely used medical techniques may be very helpful. The cell block procedure streamlines this process, inasmuch as it consists of cytopathological analysis of materials, liquids and effusions, collected from aspirated lesions such as maxillary cysts and cystic maxillary tumors. OBJECTIVE: To demonstrate the applicability of cell block technique for cytological assessment of biological material collected from cystic maxillary lesions. RESULTS: The cytological evaluation revealed that five out of 20 lesions, whose content had been processed by this technique, were odontogenic keratocystic tumors (TOCs), predominantly with keratin and always with parakeratin areas. In the other cases (five dentigerous, five radicular and five residual cysts) there were erythrocytes, inflammatory cells, and cholesterol clefts. CONCLUSION: The cytological assessment through cell block technique was useful as to establishing the differential diagnosis between TOC and other lesions, radicular, residual and dentigerous cysts.

Citologia dos lavados traqueobrônquico (LTB) e broncoalveolar (LBA) de bezerros holandeses sadios durante o primeiro mês de vida / Cytology of tracheobronchial and bronchoalveolar lavage in healthy Holteins calves during the first month of life

O período neonatal dos bezerros é um momento crítico para adaptação do recém-nascido à vida extra uterina e o sistema respiratório, um dos mais exigidos funcionalmente, é frequentemente afetado por enfermidades, redundando no prejuízo direto da sua função e acarretando perdas econômicas importantes na pecuária. O ponto básico para reduzir estas perdas, é representado pela adequada avaliação clínica dos neonatos, todavia o diagnóstico baseado exclusivamente no exame físico é muito difícil de ser estabelecido. O uso de exames complementares como a citologia do trato respiratório torna-se uma ferramenta diagnóstica importante nestes casos, porém faz-se necessário, padronizar seus achados frente às diferentes técnicas empregadas para a sua obtenção. Assim, o presente estudo propôs-se acompanhar as variações dos constituintes celulares da região traqueobrônquica e broncoalveolar obtidos por lavados respiratórios pelos métodos de traqueocentese e por colheita nasotraqueal respectivamente, durante o primeiro mês de vida de bezerros sadios. Observou-se alteração no quadro citológico ao longo do tempo, quando a região traqueobrônquica foi lavada, expresso por diminuição da porcentagem de macrófagos alveolares, com aumento de neutrófilos, possivelmente, por maior irritação local provocada pela técnica, que se repetiu sequencialmente e/ou por maior estimulo de microorganismos inalados depositados nesta região. Na região broncoalveolar, não encontraram-se variações nos constituintes celulares em função do tempo. Os resultados permitiram a conclusão que a população celular da região traqueobrônquica modificou-se ao longo das semanas de vida dos bezerros, possivelmente pela técnica empregada e/ou fisiologia normal da região, sendo representadas por maiores magnitudes de neutrófilos. De modo diverso, na região broncolaveolar, as células evidenciaram um comportamento estável durante o primeiro mês de vida dos bezerros neonatos, apresentando predomínio numérico dos macrófagos alveolares.

The neonatal calf is a critical moment for adaptation of the newborn to extra uterine life. The respiratory tract is functionally very demanded and often affected by disease, resulting in direct loss of their function and causing serious economic losses in livestock. The basic point to reduce these losses is appropriate clinical evaluation of neonates; but the diagnosis based solely in physical examination is very difficult to establish. The use of complementary analysis such cytology of the respiratory tract becomes an important diagnostic tool; however their findings must be standardized in the face of different techniques employed. This research studied the dynamics of the cellularity of the bronchoalveolar and tracheobronchial region obtained through lung lavage harvested by nasotracheal catheterization technique and tracheocenthesis respectively, during the first month of life of healthy calves. The tracheobronchial cytology was influenced by the time, showing decreased number of alveolar macrophages and greater number of neutrophils, possibly increased by local irritation caused by the technique, which was repeated sequentially, and/or through greater stimulation of inhaled microorganisms deposited in this region. In the bronchoalveolar region no variation in the cellular constituents in function of time was found. The results allowed the conclusion the cell population of the tracheobronchial region has changed over the week-old calves, possibly due to the technique used and/or to the normal region physiology, represented by higher magnitudes of neutrophils. Otherwise, the cells of the broncholaveolar region showed a stable behavior during the first month of life of newborn calves, presenting numerical predominance of alveolar macrophages.

Infección por virus de papiloma humano: asociación entre infección genital y anal-perianal / Infection with human papillomavirus: association between anal-genital and perianal infection

Describir las características de la infección por virus de papiloma humano anal y perianal asociada a la infección por genital por el mismo virus. Se seleccionaron 65 pacientes con virus de papiloma humano genital, a quienes se les realizó citología, identificación viral por reacción en cadena de polimerasa y colposcopia de región genital, ano y periano. En el Servicio de Ginecología de la Maternidad "Concepción Palacios". Se observó una frecuencia de detección del virus en ano y periano de 31,3 por ciento. En 19,67 por ciento de las pacientes hubo concordancia entre la infección en genitales y la de ano y región perianal (P > 0,397). Entre los genotipos virales hubo concordancia del 33,74 por ciento (P= 0,0053), esta correlación fue mayor para el virus 6. Fueron evaluables 38 citologías anales y perianales (59,4 por ciento) y ninguna diagnosticó anormalidades. Entre estas citologías, al hacer la reacción en cadena de polimerasa, 15 resultaron positivas para virus de papiloma humano, 21 negativas y 2 insatisfactorias. Las lesiones más frecuentes fueron subclínicas. La distribución del resultado de la anoscopia, refleja que la normalidad es lo más frecuente (67,2 por ciento). El riesgo de infección por virus de papiloma humano en ano y periano se incrementa en pacientes con infección genital. Consideramos que es importante extender la evaluación ginecológica a la región anal y perianal a pesar de las limitaciones del uso de la citología y la colposcopia

To describe the characteristics of the anal and perianal human papillomavirus infection associated with genital infection by the same virus. We selected 65 patients, with genital infection by human papillomavirus, who was made them cytology, polymerase chain reaction and colposcopy in genital region, anus and periano. Servicio de Ginecologia de la Maternidad "Concepción Palacios" The frequency of detection of papillomavirus in anus and periano was 31.3 percent. There was consistency between the genital papillomavirus infection and the anus and region parianal in 19.67 percent (P > 0,397) and between viral genotypes in 33.74 percent (P = 0,0053), this correlation was increased to virus 6. They were 38 evaluable Papanicolaou test anal and perianal (59.4 percent) and none diagnosed abnormalities. Among these, 15 were polymerase chain reaction positive for papillomavirus, 21 negative and 2 unsatisfactory. The most common lesions were subclinical. The distribution of the anoscopia result reflects normal is most often (67.2 percent). The risk of HPV infection in anus and periano is increased in patients with genital infection. We believe it is important to extend the gynecologic evaluation to the anal and perianal region despite the limitations of the use of Papanicolaou test and the colposcopy

Avaliação clínica e molecular de cães com erliquiose / Clinical and molecular evaluation of dogs with ehrlichiosis

A erliquiose monocítica canina é uma doença cosmopolita causada por Ehrlichia canis e transmitida pelo carrapato Rhipicephalus sanguineus, sendo frequentemente diagnosticada em cães em todo o Brasil. Este trabalho teve por objetivo investigar citológica e molecularmente a infecção por Ehrlichia em 195 cães atendidos no Hospital Veterinário da Universidade Federal de Mato Grosso, analisando os achados clínicos e laboratoriais. Nos 48 cães atendidos com citologia positiva para Ehrlichia sp., foi possível verificar a diversidade de sinais, com predominância estatisticamente significativa de palidez de mucosas (P≤0,05), assim como variados achados hematológicos, ocorrendo tanto anemia, leucopenia e trombocitopenia, quanto normalidade ou aumento dessas células. Ocorreu aumento das proteínas plasmáticas, com hiperglobulinemia, sem, no entanto, haver diferença significativa (P≥0,05), apesar de esse achado ser frequente nessa afecção. Por meio do PCR nested, confirmou-se a infecção por E. canis em cães da cidade de Cuiabá.

The canine monocytic ehrlichiosis is a cosmopolitan disease, caused by Ehrlichia canis, transmitted by ticks Rhipicephalus sanguineus that has been frequently diagnosed in dogs throughout the country. This study aimed to investigate the cytological and molecular Ehrlichia infection in 195 dogs examined at the University Veterinary Hospital of Mato Grosso, by analyzing the clinical and laboratory findings. In 48 dogs with positive cytology for Ehrlichia sp it was possible to detect the diversity of signs, with predominance statistically significant of pallor of mucous membranes (P≤0.05) as well as several hematological findings, occurring anemia, leukopenia and thrombocytopenia, or increased as normal cells. There was increased of plasma proteins, with hyperglobulinemia, however without any significant difference (P≥0.05), although this finding is common in that infection. Through the nested PCR technique it was possible to confirm the infection by E. canis in the city of Cuiaba.

Detecção de fibronectina e laminina em cistos teciduais de toxoplasma gondii: ensaios imunocitoquímicos / Detection of fibronectin and laminin in toxoplasma gondii tissue cysts: immunocytochemical assays

Aims: To analyze the existence and distribution of some matrix proteins in tissue cysts of Toxoplasma gondii. Methods: Laminin and fibronectin in tissue cysts of Toxoplasma gondii were detected by confocal microscopy and transmission electron microscopy. Results: Ultrastructural immunocytochemistry showed both glycoproteins in the granular region of tissue cysts, cystic matrix, micronemes, rhoptries, dense granules and rarely at the membrane of bradyzoites of Toxoplasma gondii. Conclusions: The presence of both laminin and fibronectin in secretory organelles and in the apical region of bradyzoites suggests that exocytosis of these glycoproteins can contribute to their interaction with host cells, besides composing the cyst matrix of Toxoplasma gondii.

Calidad diagnóstica en pacientes con lesiones premalignas y malignas de cuello uterino: Ambulatorio Palo Negro, Estado Aragua. 2003-2005 / Diagnostic quality of cytology exams in patients with premalignant and malignant lesions of the uterine cervix: Consults in the Palo Negro, State Aragua. Outpatient clinic from 2003 through 2005

Con el propósito de estimar la calidad diagnóstica de las citologías de pacientes con lesiones premalignas y malignas de cuello uterino que acudieron a la consulta de patología de cuello Uterino en el Ambulatorio de Palo Negro durante el período 2003-2005, se realizó un estudio de concordancia, para lo cual se revisaron 60 reportes citológicos e histológicos; obteniendo así el porcentaje de concordancia citohistológico en una primera observación. Posteriormente se seleccionaron los casos no concordantes, siendo sometidas a una segunda revisión por dos especialistas del área, calculándose la concordancia intra e inter observador aplicando el índice de Kappa. El 85% de las muestras citológicas evaluadas fueron satisfactorias, con un 7,84% asociadas a inflamatorio severo. El 53.92% de anormalidades de las células escamosas estuvo representado por el LIE de Bajo Grado y un 39% por NIC I; la concordancia citohistológica para una primera revisión fue de 41,7% correspondiendo 54,76% a los NIC I, con un índice de Kappa de -0.0746, el cual es considerado como un índice pobre de concordancia e igualmente en la segunda observación predomino una fuerza de concordancia pobre a débil siendo necesario implementar medidas correctivas que mejoren los índices de concordancia citohistológica, para lograr diagnósticos citológicos mas confiables, y con ellos mejorar la calidad diagnóstica de las citologías.

With the objective of estimating the accuracy of diagnostic in smears perform on patients with premalignant and malignant Uterine Cervix injuries in the ambulatory of Palo Negro, during the period of 2003-2005, an agreement study was performed based on the review of 60 smear and histological reports; obtaining the percentage of cytohistological agreements on a first observation. Afterwards, all non-agree cases were selected and were submitted to a second review by two specialists in the field, calculating the agreement intra and inter observer by applying the Kappa index. 85% of the evaluated smear samples were satisfactory, with 7,84% been associated to severe inflammation. 53,9% of squamous cell anomalies was represented by a low level LIE and 39% by the NIC I. The cytohistological agreement for a first revision was 41,7% corresponding 54,76% to the NIC I, with a Kappa index of -0.0746, wich is considered a poor agreement index. Likewise, a poor and weak agreement predominated in a second observation as it was necessary to implement corrective measures to improve the index of cytohistological agreements to obtain more reliable and more accurate diagnostics, hence improving the quality of smear diagnostic.

Técnicas e sítios de coleta de medula óssea em cães e gatos / Techniques and bone marrow sites sampling in dogs and cats

Atualmente, o incremento das pesquisas enfoca a medula óssea como fonte potencial para o tratamento de doenças, uma vez que seu uso como diagnóstico já é largamente empregado. Os objetivos deste artigo são revisar os melhores acessos à medula óssea e destacar a importância desse material como diagnóstico e tratamento de doenças. São abordadas particularidades sobre as técnicas de coleta e as complicações observadas pelos autores, a fim de facilitar os procedimentos, tornando-os mais seguros.

Currently, the research focuses on bone marrow as a potential source for the treatment of diseases, since its use as a diagnosis is already largely employed. This paper aims to promote a practical review on the best access to the bone marrow and the importance of this material as diagnosis and treatment. Sampling techniques are observed and detailed by the authors, in order to facilitate the procedures and make them safer.