Melanoma primário de mama: relato de caso / Primary breast melanoma: case report

O melanoma primário de mama em sítio parenquimatoso é um tumor raro. Por sua baixa incidência, desconhece-se sua apresentação clínica usual, a evolução natural da doença, bem como resposta ao tratamento e seu prognóstico. É por esse motivo que se faz necessária uma boa investigação diagnóstica a fim de se obter precocemente o diagnóstico correto para se estabelecer a abordagem terapêutica adequada para cada paciente. Desse modo, relata-se o caso de paciente feminino, 61 anos, branca, encaminhada devido a nódulo palpável em mama direita e alteração mamográfica com BI-RADS 3, que teve diagnóstico de melanoma de parênquima mamário confirmado por exame anatomopatológico complementado por estudo imuno-histoquímico. Assim, com o objetivo desse trabalho de alcançar uma maior compreensão do assunto para que casos semelhantes a esse sejam futuramente abordados de maneira precoce e que garanta ao paciente o melhor cuidado, serão discutidos os aspectos relacionados à incidência do melanoma de mama, às dificuldades diagnósticas, ao prognóstico e às abordagens terapêuticas.

Primary melanoma in breast parenchyma is a rare tumor. Because of its low incidence, it is unknown its usual clinical presentation, the natural course of the disease and its response to treatment and prognosis. For this reason, a good diagnostic investigation is necessary in order to get the correct diagnosis as soon as possible to establish the appropriate therapeutic approach for each patient. Thus, we report a female patient case, 61 years-old, white, referred due to a palpable mass in the right breast and a mammographic alteration that shows BI-RADS 3, who had breast parenchyma melanoma diagnosed and confirmed by pathological examination complemented by immunohistochemical study. Under these circumstances, with the objective of this work to achieve a greater understanding of the subject so that such cases are identified as early as possible in the future and ensure the best patient care, aspects related to the incidence of breast melanoma, diagnostic difficulties, prognostic and therapeutic approaches will be discussed.

Remodelamento miocárdico após grandes infartos converte potenciação pós-pausa em decaimento da força em ratos / Myocardial remodeling after large infarcts in rat converts post rest-potentiation in force decay / Miocárdio remodelado después de grandes infartos en ratas convierte potenciación post-pausa en disminucion de la fuerza

FUNDAMENTO: A Contração Pós-Repouso (CPR) do músculo cardíaco fornece informações indiretas sobre a manipulação de cálcio intracelular. OBJETIVO: Nosso objetivo foi estudar o comportamento da CPR e seus mecanismos subjacentes em camundongos com infarto do miocárdio. MÉTODOS: Seis semanas após a oclusão coronariana, a contratilidade dos Músculos Papilares (MP) obtidos a partir de camundongos submetidos à cirurgia sham (C, n = 17), com infarto moderado (MMI, n = 10) e grande infarto (LMI, n = 14), foi avaliada após intervalos de repouso de 10 a 60 segundos antes e depois da incubação com cloreto de lítio (Li+) em substituição ao cloreto de sódio ou rianodina (Ry). A expressão proteica de SR Ca(2+)-ATPase (SERCA2), trocador Na+/Ca2+ (NCX), fosfolambam (PLB) e fosfo-Ser (16)-PLB foi analisada por Western blotting. RESULTADOS: Os camundongos MMI apresentaram potenciação de CPR reduzida em comparação aos camundongos C. Em oposição à potenciação normal para camundongos C, foram observadas degradações de força pós-repouso nos músculos de camundongos LMI. Além disso, a Ry bloqueou a degradação ou potenciação de PRC observada em camundongos LMI e C; o Li+ inibiu o NCX e converteu a degradação em potenciação de CPR em camundongos LMI. Embora os camundongos MMI e LMI tenham apresentado diminuição no SERCA2 (72 ± 7% e 47 ± 9% de camundongos controle, respectivamente) e expressão protéica de fosfo-Ser16-PLB (75 ± 5% e 46 ± 11%, respectivamente), a superexpressão do NCX (175 ± 20%) só foi observada nos músculos de camundongos LMI. CONCLUSÃO: Nossos resultados mostraram, pela primeira vez, que a remodelação miocárdica pós-IAM em camundongos pode mudar a potenciação regular para degradação pós-repouso, afetando as proteínas de manipulação de Ca(2+) em miócitos.

BACKGROUND: Post-rest contraction (PRC) of cardiac muscle provides indirect information about the intracellular calcium handling. OBJECTIVE: Our aim was to study the behavior of PRC, and its underlying mechanisms, in rats with myocardial infarction. METHODS: Six weeks after coronary occlusion, the contractility of papillary muscles (PM) obtained from sham-operated (C, n=17), moderate infarcted (MMI, n=10) and large infarcted (LMI, n=14) rats was evaluated, following rest intervals of 10 to 60 seconds before and after incubation with lithium chloride (Li+) substituting sodium chloride or ryanodine (Ry). Protein expression of SR Ca(2+)-ATPase (SERCA2), Na+/Ca2+ exchanger (NCX), phospholamban (PLB) and phospho-Ser(16)-PLB were analyzed by Western blotting. RESULTS: MMI exhibited reduced PRC potentiation when compared to C. Opposing the normal potentiation for C, post-rest decays of force were observed in LMI muscles. In addition, Ry blocked PRC decay or potentiation observed in LMI and C; Li+ inhibited NCX and converted PRC decay to potentiation in LMI. Although MMI and LMI presented decreased SERCA2 (72±7% and 47±9% of Control, respectively) and phospho-Ser16-PLB (75±5% and 46±11%, respectively) protein expression, overexpression of NCX (175±20%) was only observed in LMI muscles. CONCLUSION: Our results showed, for the first time ever, that myocardial remodeling after MI in rats may change the regular potentiation to post-rest decay by affecting myocyte Ca(2+) handling proteins.

FUNDAMENTO: La Contracción pos pausa (CPP) del músculo cardíaco provee informaciones indirectas sobre la manejo del calcio intracelular. OBJETIVO: Nuestro objetivo fue estudiar el comportamiento de la CPP y sus mecanismos subyacentes en Ratas con infarto de miocardio. MÉTODOS: Seis semanas después de la oclusión coronaria, la contractilidad de los Músculos Papilares (MP) obtenidos a partir de Ratas sometidos a falsa cirurgia (C, n = 17), con infarto moderado (MMI, n = 10) y gran infarto (LMI, n = 14), fue evaluada después de pausas de estímulos de 10 a 60 segundos antes y después de la incubación con cloruro de litio (Li+) en substitución del cloruro de sodio o rianodina (Ry). La expresión proteica de SR Ca(2+)-ATPasa (SERCA2), intercambiador Na+/Ca2+ (NCX), fosfolamban (PLB) y fosfo-Ser (16)-PLB fue analizada por Western blotting. RESULTADOS: Los Ratas MMI presentaron potenciación de CPP reducida en comparación a los Ratas C. En oposición a la potenciación normal para Ratas C, fueron observadas decaimientos de fuerza post-reposo en los músculos de Ratas LMI. Además de eso, la Ry bloqueó la decaimiento o potenciación de PRC observada en Ratas LMI y C; el Li+ inhibió el NCX y convirtió la decaimiento en potenciación de CPP en Ratas LMI. Aunque los Ratas MMI y LMI hayan presentado disminución en el SERCA2 (72 ± 7% y 47 ± 9% de Ratas control, respectivamente) y expresión proteica de fosfo-Ser16-PLB (75 ± 5% y 46 ± 11%, respectivamente), la superexpresión del NCX (175 ± 20%) sólo fue observada en los músculos de Ratas LMI. CONCLUSIÓN: Nuestros resultados mostraron, por primera vez, que el remodelado miocárdico post-IAM en Ratas puede cambiar la potenciación regular para decaimiento post-reposo, afectando las proteínas de manejo del Ca(2+) en miocitos.

Repercussions of training and detraining by water-based exercise on functional fitness and quality of life: a short-term follow-up in healthy older women

OBJECTIVE: To evaluate the effects of short-term exercise detraining on the functional fitness of older women after a 12-week water-based exercise (WE) program. METHODS: Healthy older women (trained (TR) group) were submitted to 12 weeks WE (three 45 min sessions per week) followed by a 6-week detraining period. A group of aged-matched women without any exercise training (UN group) were evaluated during the same period. The aerobic power, measured by VO2max and 800 meters performance, and the neuromuscular fitness and quality of life were evaluated. All assessments were made at baseline, after 12 weeks of training and after 4 and 6 weeks of detraining. RESULTS: No changes were found for the UN group during the follow-up study, but WE induced significant improvement in aerobic capacity, neuromuscular fitness and quality of life score. However, the upper and lower body strength, agility, flexibility, and body balance returned to UN levels (p>0.05) after 6 weeks of detraining. CONCLUSIONS: The results confirmed that 12 weeks of WE improves the functional fitness parameters and quality of life of older women. However, after a short detraining period of 4-6 weeks, the neuromuscular parameters and the quality of life score returns to baseline or untrained subject levels.

Physical exercise improves the functional capacity and quality of life in patients with heart failure

OBJECTIVE: The purpose of this study was to investigate the effects of physical exercise on the functional capacity and quality of life in heart failure patients. METHODS: Forty-two patients of both sexes with heart failure of NYHA class II and III with different etiologies were randomly divided into untrained or trained groups. The six-month exercise program consisted of aerobic training, muscle strength training, agility and joint flexibility activities. Physical fitness was evaluated by testing the performance on these trained components. Quality of life was evaluated by scored answers to a standardized questionnaire involving multiple domains. RESULTS: Baseline values did not differ between groups. Improvement in the trained group was identified in all components of functional capacity when compared to the untrained group (p < 0.001). Quality of life improved in the trained patients concerning physical, psychological, social and environmental domains (p < 0.001), whereas no significant change was found in the untrained patients. CONCLUSIONS: Guided and monitored physical exercise is safe and has the potential to improve functional capacity and quality of life in heart failure patients with multiple etiologies.

Remodelamento miocárdico: o cardiomiócito, a função do órgão / Cardiac remodeling: the cardiomyocyte, the cardiac function

Remodelamento miocárdico é o conjunto de modificações gênicas, moleculares, celulares e intersticiais que ocorrem no miocárdio e que se expressam clinicamente por alterações do tamanho, da forma e da função do coração. Este texto focaliza as modificações incidentes no cardiomiócito e as anormalidades decorrentes para a função cardíaca. Modificações...