Potential role of vacuum-assisted procedures in resecting breast cancers and highlighting selection criteria to support future trials.

Purpose: The purpose of this study was to evaluate the role of vacuum-assisted biopsy (VAB) in resecting breast cancers. Methods: Retrospective database analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery. Excision following VAB was defined as complete resection (CR) if there was no residual tumor in the surgical specimen, minimal residual disease (MRD) if residual tumor ≤ 3 mm, gross residual disease (GRD) if residual tumor > 3 mm, and upgrade from DCIS on VAB to IC. CR and MRD were combined as potentially resected percutaneously (PRP). GRD and those with upgrade to IC were determined not eligible for percutaneous resection (NPR). Factors predictive of PRP were evaluated. Results: Mean age was 55.6 years (20-91; SD: 12,27). CR was seen in 29 of 116 cases (25%), MRD in 18 of 116 cases (15.5%), GRD in 64 of 116 cases (55.2%), and five of 116 cases (4.3%) were upgraded from DCIS to IC, and those groups combined represented 47 cases of PRP (40.5%) and 69 (59,5%) of NPR. For 77 tumors ≤ 10 mm, 45 (58.5%) were PRP. Multivariate analysis reveals significance for enlarged VAB (EVAB) (p = 0.008, OR: 4.4, 95% CI), low/intermediate nuclear grade (p < 0.001, OR: 12.5, 95% CI) and final tumor size (T) ≤ 10 mm (p = 0.001, OR: 50.1, 95% CI) for PRP. Conclusions: This study showed that lesions completely excised with VAB that were cancer could have been treated with VAB rather than surgery but tumor selection in terms of subtype and size is important.

Biological activity of laminin/polylaminin-coated poly-ℇ-caprolactone filaments on the regeneration and tissue replacement of the rat sciatic nerve.

Unlike the central nervous system, peripheral nerves can regenerate after injury. However, depending on the size of the lesion, the endogenous regenerative potential is not enough to replace the lost nerve tissue. Many strategies have been used to generate biomaterials capable of restoring nerve functions. Here, we set out to investigate whether adsorbing the extracellular matrix protein, laminin (LM), to poly-ℇ-caprolactone (PCL) filaments would enhance functional nerve regeneration. Initial in vitro studies showed that explants of dorsal root ganglia (DRGs) of P1 neonate mice exhibited stronger neuritogenesis on a substrate of LM that had been previously polymerized (polylaminin [polyLM]) than on ordinary LM. On the other hand, when silicone tubes filled with PCL filaments were used to bridge a 10-mm sciatic nerve gap in rats, only filaments coated with LM improved tissue replacement beyond that obtained with empty tubes. Motor function recovery correlated with tissue replacement as only LM-coated filaments consistently improved motor skills. Finally, analysis of the lateral gastrocnemius muscle revealed that the LM group presented twice the amount of α-bungarotixin-labeled motor plates. In conclusion, although polyLM was more effective in stimulating growth of sensory fibers out of DRGs in vitro, LM adsorbed to PCL filaments exhibited the best regenerative properties in inducing functional motor recovery after peripheral injury in vivo.

Dual Contribution of Mesenchymal Stem Cells Employed for Tissue Engineering of Peripheral Nerves: Trophic Activity and Differentiation into Connective-Tissue Cells.

Adult peripheral nerves in vertebrates can regrow their axons and re-establish function after crush lesion. However, when there is extensive loss of a nerve segment, due to an accident or compressive damage caused by tumors, regeneration is strongly impaired. In order to overcome this problem, bioengineering strategies have been employed, using biomaterials formed by key cell types combined with biodegradable polymers. Many of these strategies are successful, and regenerated nerve tissue can be observed 12 weeks after the implantation. Mesenchymal stem cells (MSCs) are one of the key cell types and the main stem-cell population experimentally employed for cell therapy and tissue engineering of peripheral nerves. The ability of these cells to release a range of different small molecules, such as neurotrophins, growth factors and interleukins, has been widely described and is a feasible explanation for the improvement of nerve regeneration. Moreover, the multipotent capacity of MSCs has been very often challenged with demonstrations of pluripotency, which includes differentiation into any neural cell type. In this study, we generated a biomaterial formed by EGFP-MSCs, constitutively covering microstructured filaments made of poly-ε-caprolactone. This biomaterial was implanted in the sciatic nerve of adult rats, replacing a 12-mm segment, inside a silicon tube. Our results showed that six weeks after implantation, the MSCs had differentiated into connective-tissue cells, but not into neural crest-derived cells such as Schwann cells. Together, present findings demonstrated that MSCs can contribute to nerve-tissue regeneration, producing trophic factors and differentiating into fibroblasts, endothelial and smooth-muscle cells, which compose the connective tissue.

Biological behavior of mesenchymal stem cells on poly-ε-caprolactone filaments and a strategy for tissue engineering of segments of the peripheral nerves.

INTRODUCTION: Peripheral nerves may fail to regenerate across tube implants because these lack the microarchitecture of native nerves. Bone marrow mesenchymal stem cells (MSC) secrete soluble factors that improve the regeneration of the peripheral nerves. Also, microstructured poly-caprolactone (PCL) filaments are capable of inducing bands of Büngner and promote regeneration in the peripheral nervous system (PNS). We describe here the interaction between PCL filaments and MSC, aiming to optimize PNS tubular implants. METHODS: MSC were plated on PCL filaments for 48 h and the adhesion profile, viability, proliferation and paracrine capacity were evaluated. Also, Schwann cells were plated on PCL filaments covered with MSC for 24 h to analyze the feasibility of the co-culture system. Moreover, E16 dorsal root ganglia were plated in contact with PCL filaments for 4 days to analyze neurite extension. Right sciatic nerves were exposed and a 10 mm nerve segment was removed. Distal and proximal stumps were reconnected inside a 14-mm polyethylene tube, leaving a gap of approximately 13 mm between the two stumps. Animals then received phosphate-buffered saline 1×, PCL filaments or PCL filaments previously incubated with MSC and, after 12 weeks, functional gait performance and histological analyses were made. Statistical analyses were made using Student's unpaired t-test, one-way analysis of variance (ANOVA) or two-way ANOVA followed by Bonferroni post-test. RESULTS: MSC were confined to lateral areas and ridges of PCL filaments, aligning along the longitudinal. MSC showed high viability (90 %), and their proliferation and secretion capabilities were not completely inhibited by the filaments. Schwann cells adhered to filaments plated with MSC, maintaining high viability (90 %). Neurites grew and extended over the surface of PCL filaments, reaching greater distances when over MSC-plated filaments. Axons showed more organized and myelinized fibers and reinnervated significantly more muscle fibers when they were previously implanted with MSC-covered PLC filaments. Moreover, animals with MSC-covered filaments showed increased functional recovery after 12 weeks. CONCLUSIONS: We provide evidence for the interaction among MSC, Schwann cells and PCL filaments, and we also demonstrate that this system can constitute a stable and permissive support for regeneration of segments of the peripheral nerves.

Tuberculosis: which patients do not identify their contacts?

SETTING: It is not known what the magnitude of non-identified TB contacts is in our country, or the reasons why contacts at risk are not identified. OBJECTIVE: The purpose of this study was to analyze the determinants associated with non-identification of contacts. DESIGN: This cross-sectional study included all cases of pulmonary tuberculosis diagnosed and treated in the Chest Disease Centre of Vila Nova de Gaia and their contacts, from 1st January to 31st December 2010. It included information collected from patients related to the identification of contacts in risk, and the information collected by the Public Health Unit during home, work and social places visits. RESULTS: During the period of study, 61 cases of pulmonary TB were diagnosed: 41 cases (67.2%) identified all their contacts and 20 cases (32.8%) did not. 646 contacts were identified: 154 (23.8%) were identified only by the Public Health Unit (mean age of 40.67), and 492 (76.2%) were identified by the index cases (mean age of 33.25), (p=0.001). A mean of 10.59 contacts were identified per index case, of which, 83 (19.3%) screened positive. From those identified by the Public Health Unit, 10 (9.8%) had LTBI and 5 (4.9%) had active TB, and by the index case 61 (18.6%) had LTBI and 7 (2.1%) had active TB (crude OR=1.52; CI=0.83-2.79). The multivariate analysis showed that employment (adjusted OR=4.82; 95%CI=1.71-13.54) was associated to non-identification of contacts and patients preferably tended to identify relatives and co-habitants (adjusted OR=0.22; 95%CI=0.10-0.47). CONCLUSION: TB patients tend to identify relatives and co-habitant contacts; contact at place of employment was found to be an independent risk factor for not being identified.

Radiofrequency assisted liver resection: analysis of 604 consecutive cases.

BACKGROUND: Intraoperative blood loss is an important factor contributing to morbidity and mortality in liver surgery. To address this we developed a bipolar radiofrequency (RF) device, the Habib 4X, used specifically for hepatic parenchymal transection. The aim of this study was to prospectively assess the peri-operative data using this technique. METHODS: Between 2001 and 2010, 604 consecutive patients underwent liver resections with the RF assisted technique. Clinico-pathological and outcome data were collected and analysed. RESULTS: There were 206 major and 398 minor hepatectomies. Median intraoperative blood loss was 155 (range 0-4300)ml, with a 12.6% rate of transfusion. There were 142 patients (23.5%) with postoperative complications; none had bleeding from the resection margin. Only one patient developed liver failure and the mortality rate was 1.8%. CONCLUSIONS: RF assisted liver resection allows major and minor hepatectomies to be performed with minimal blood loss, low blood transfusion requirements, and reduced mortality and morbidity rates.

Ectopia testicular cruzada en niño indígena / Crossed testicular ectopia in indigenous child

La ectopia testicular cruzada es una entidad extremadamente rara, caracterizada por la migración de ambos testículos a un mismo canal inguinal, muchas veces asociada con hernia inguinal sintomática y criptorquidiadel lado contralateral. Cerca de 100 casos habían sido publicados en la literatura mundial. Reportamos un caso de ectopia testicular cruzada en niño indígena brasileño, de dos años de edad, con buenísima evolución postoperatoria (AU)

The crossed testicular ectopia is an extremely rare entity, characterized by migration of both testicles in the same inguinal canal, often associated with symptomatic inguinal hernia and cryptorchidism in the contralateral side. About one hundred cases have been published in the literature. Were port a case of crossed testicular ectopia in brazilian indigenous boy, aged two years old, with a favorable post operative (AU)

[Crossed testicular ectopia in indigenous child]. / Ectopia testicular cruzada en niño indígena.

The crossed testicular ectopia is an extremely rare entity, characterized by migration of both testicles in the same inguinal canal, often associated with symptomatic inguinal hernia and cryptorchidism in the contralateral side. About one hundred cases have been published in the literature. We report a case of crossed testicular ectopia in brazilian indigenous boy, aged two years old, with a favorable post operative.

Trophic activity derived from bone marrow mononuclear cells increases peripheral nerve regeneration by acting on both neuronal and glial cell populations.

A rat model of complete sciatic nerve transection was used to evaluate the effect of bone marrow mononuclear cells (BMMC) transplanted to the injury site immediately after lesion. Rats treated with BMMC had both sensory and motor axons reaching the distal stump earlier compared to untreated animals. In addition, BMMC transplantation reduced cell death in dorsal root ganglia (DRG) compared to control animals. Transplanted BMMC remained in the lesion site for several days but there is no evidence of BMMC differentiation into Schwann cells. However, an increase in the number of Schwann cells, satellite cells and astrocytes was observed in the treated group. Moreover, neutralizing antibodies for nerve growth factor (NGF) (but not for brain-derived neurotrophic factor and ciliary-derived neurotrophic factor) added to the BMMC-conditioned medium reduced neurite growth of sensory and sympathetic neurons in vitro, suggesting that BMMC release NGF, improve regeneration of the sciatic nerve in the adult rat and stimulate Schwann and satellite cell proliferation or a combination of both.

Thyroid volume is associated with family history of thyroid disease in pregnant women with adequate iodine intake: a cross-sectional study in southern Brazil.

UNLABELLED: Maternal euthyroidism is important for fetal neural development. For this reason, adequate iodine nutrition during pregnancy is an important public health objective and should be periodically revised. The objective of this study was to measure urinary iodine (UI) excretion and the factors associated with thyroid volume (TV), in a group of healthy pregnant women in southern Brazil, to evaluate iodine nutrition. The median UI of the 147 women was 224 microg/l (P25=164 microg/l and P75=286 microg/l). Serum levels of free T4 and thyroglobulin did not correlate with UI, but there was a weak inverse correlation between serum TSH levels and UI (r=-0.200; p=0.02). TV, calculated through ultrasound in 57 women, was significantly associated with family history of thyroid diseases (p=0.002) and BMI (p=0.03), but there was no association with UI, corrected or not for creatinine, serum free T4, TSH or thyroglobulin, current or past smoking, gestational age, parity or oral contraceptive. CONCLUSIONS: The healthy pregnant women studied had adequate iodine intake. In this situation, the main thyroid size determinants are probably genetic factors.

Ganglioside 9-O-acetyl GD3 expression is upregulated in the regenerating peripheral nerve.

Evidence accumulates suggesting that 9-O-acetylated gangliosides, recognized by a specific monoclonal antibody (Jones monoclonal antibody), are involved in neuronal migration and axonal growth. These molecules are expressed in rodent embryos during the period of axon extension of peripheral nerves and are absent in adulthood. We therefore aimed at verifying if these molecules are re-expressed in adult rats during peripheral nerve regeneration. In this work we studied the time course of ganglioside 9-O-acetyl GD3 expression during regeneration of the crushed sciatic nerve and correlated this expression with the time course of axonal regeneration as visualized by immunohistochemistry for neurofilament 200 in the nerve. We have found that the ganglioside 9-O-acetyl GD3 is re-expressed during the period of regeneration and this expression correlates spatio-temporally with the arrival of axons to the lesion site. Confocal analysis of double and triple labeling experiments allowed the localization of this ganglioside to Schwann cells encircling growing axons in the sciatic nerve. Explant cultures of peripheral nerves also revealed ganglioside expressing reactive Schwann cells migrating from the normal and previously crushed nerve. Ganglioside 9-O-acetyl GD3 is also upregulated in DRG neurons and motoneurons of the ventral horn of spinal cord showing that the reexpression of this molecule is not restricted to Schwann cells. These results suggest that ganglioside 9-O-acetyl GD3 may be involved in the regrowth of sciatic nerve axons after crush being upregulated in both neurons and glia.

An autochthonous case of Echinococcus vogeli Rausch & Bernstein, 1972 polycystic echinococcosis in the state of Rondônia, Brazil.

The present case report refers to a patient from the State of Rondônia, North region of Brazil, attended with clinical suspicion of hepatic echinococcosis. Examination by imaging (ultrasonography and computerized tomography) revealed a conglomerate of cystic lesions, with mobile contents within the cyst. The serology (immunoblot) for Echinococcus sp. was positive (21 and 31 kDa bands). This case is the first reported in Rondônia, suggesting the need to investigate the polycystic echinococcosis in individuals with hepatic cysts from areas of tropical forest and hunting habits where wild life was present as wild dogs, cats and rodents, particularly Agouti paca (paca) and Dasyprocta aguti (agouti).

An autochthonous case of Echinococcus vogeli Rausch & Bernstein, 1972 polycystic echinococcosis in the State of Rondônia, Brazil

The present case report refers to a patient from the State of Rondônia, North region of Brazil, attended with clinical suspicion of hepatic echinococcosis. Examination by imaging (ultrasonography and computerized tomography) revealed a conglomerate of cystic lesions, with mobile contents within the cyst. The serology (immunoblot) for Echinococcus sp. was positive (21 and 31 kDa bands). This case is the first reported in Rondônia, suggesting the need to investigate the polycystic echinococcosis in individuals with hepatic cysts from areas of tropical forest and hunting habits where wild life was present as wild dogs, cats and rodents, particularly Agouti paca (paca) and Dasyprocta aguti (agouti)

[The use of psychotropics by dental patients in Minas Gerais, Brazil]. / Utilização de psicofármacos por pacientes odontológicos em Minas Gerais, Brasil.

In Brazil, psychotropics and other drugs are often indiscriminately overused. Nevertheless, there are few studies regarding the use of psychotropics, especially among dental patients. The purpose of this study was to assess the prevalence of psychotropic consumption among patients of the general primary care clinic of the Dentistry School at the Minas Gerais Federal University, in Brazil. To collect data, students working in the clinic interviewed all patients over 12 years of age seen at the clinic during June 1997 and asked them about their use of psychotropics during the preceding 2-week and 12-month periods. The results showed that 4% of the patients had used psychotropic drugs in the 2 weeks before the study and that 10% of them had used psychotropics in the preceding 12 months. The drugs used most frequently in the 12-month period were anxiolytics (around 40% of total use). The median age of the patients was 23 years old. Persons under the median had used psychotropics less in comparison with older persons (P < 0.01). A significant association (P < 0.05) was found between using drugs and being female, and also between the use of drugs and being a housekeeper or a housewife (P < 0.03). Patients with a regular relationship (married or living together) used more psychotropics than patients who were single, widowed, or divorced (P < 0.03). There was no association between the use of drugs and the level of education. Even though information on the use of psychotropics is important for dental diagnosis and planning, only 40% of the students said they noted this information in their patients' charts. That fact suggests that dental student education may be lacking in this regard and that dentistry training should take into consideration the issue of patients' use of drugs.

[Determination of the dispersion of microorganisms in the course of dental surgical activity]. / Verificação da dispersão de respingos durante o trabalho do cirurgião-dentista.

The professionals and patients involved in dental examinations are at risk for infection by various disease-causing bacteria, viruses, and fungi, such as those responsible for hepatitis, tuberculosis, herpes, and AIDS. It is known that aerosols and spatter containing pathogenic microorganisms can spread during an examination. Nevertheless, some dental clinics are designed to have multiple examination areas in the same room, with no physical barriers between them. The objective of this study was to verify the reach of spatter resulting from the use of a triple syringe and high-rotation turbine during five simulated exams in a collective clinic, bearing in mind that spatter can contain the patient's saliva and blood. To facilitate tracking of the spatter, aniline dye (pink, blue, yellow, green, and brown) was added to the water in the appropriate receptacle in each of the five units. The room, the equipment, and the patient's and operator's clothing were covered with white paper. A high concentration of spatter was observed on the chair, the operator, and the floor of each unit, and it also appeared on the chairs and trays of the surrounding units. The maximum distance reached by spatter was 1.82 m from a point on the chair corresponding to the position of the patient's mouth. During real simultaneous examinations, the surrounding chairs and their patients and operators, as well as the trays containing sterilized instruments, are within spatter range. Therefore, there is a real possibility of cross-infection, and physical barriers should be placed between the units. This study also confirmed the need for protection of the operator's face, body, hair, and arms, since these regions were heavily affected by spatter.

Subtotal splenectomy for treatment of severe splenic injuries.

OBJECTIVE: The spleen is an organ of the defense system with important roles in filtering functions, phagocytosis, and immunoglobulin production. Septic phenomena are severe complications that may occur after total splenectomy. To avoid these adverse effects, the preservation of the spleen is indicated. However, in the presence of severe spleen damage, lesions of the splenic pedicle, or both, complete removal of the spleen has been considered unavoidable. METHODS: The present paper presents the preservation of the upper splenic pole supplied by the splenogastric vessels in six patients with severe injuries of the spleen and its pedicle. RESULTS: All patients had good postoperative courses. CONCLUSIONS: Subtotal splenectomy may be useful in the treatment of severe injuries of the distal part of the spleen, when the vessels of its pedicle are damaged, or both.