Caracterización del desempeño en Histología Humana del especialista en formación de anatomía patológica / Cauterization of Performance in Human Histology of Specialists Being Trained in Pathological Anatomy

Introducción: Para el desarrollo de cualquier sociedad es importante el recurso humano competente, lo que implica enrumbar los esfuerzos hacia el mejoramiento del desempeño profesional en aras de lograr que su impacto contribuya al progreso y desarrollo humanos. Objetivo: Caracterizar el desempeño profesional en Histología Humana de los especialistas en formación de Anatomía Patológica del Hospital Universitario General Calixto García durante el período 2015-2020. Métodos: Se realizó un estudio descriptivo-observacional con enfoque mixto. Coincidieron el universo y la muestra, compuestos por 13 especialistas en formación que se encontraban en el primer semestre del primer año de la especialidad y 8 profesores de la especialidad de Anatomía Patológica. El muestreo fue por conveniencia. Se utilizaron métodos teóricos y empíricos. Se empleó una Estadística descriptiva, en particular el análisis porcentual, y la frecuencia absoluta y relativa, a partir de los programas Microsoft Excel y el SPSS, los que permitieron el procesamiento cuantitativo de los instrumentos aplicados. Se empleó la tecnología para la determinación de problemas y potencialidades de la Educación Avanzada. Conclusiones: La aplicación de la tecnología antes mencionada permitió caracterizar el estado actual del desempeño profesional en Histología Humana del especialista en formación de Anatomía Patológica, lo cual reveló carencias y dificultades en las dimensiones: conocimiento teórico-práctico en Histología Humana, comportamiento humano, y comportamiento ético y bioético. La triangulación metodológica aplicada a los resultados de los instrumentos contribuyó a la identificación del inventario de problemas y potencialidades(AU)

Introduction: Competent human resources are important for the development of any society, which implies directing efforts towards the improvement of professional performance in order to achieve their impact on and such contribution to human progress and development. Objective: To characterize the professional performance in Human Histology of specialists being trained in Pathological Anatomy at Hospital Universitario General Calixto García during the period 2015-2020. Methods: A descriptive-observational study with a mixed approach was conducted. The study universe and the sample coincided, composed of 13 specialists being trained in their first semester of the specialty's first academic year and 8 professors of the Pathological Anatomy specialty. The sampling was by convenience. Theoretical and empirical methods were used. Descriptive statistics were used, particularly the percentage analysis, as well as absolute and relative frequency, by using the programs Microsoft Excel and SPSS, which allowed the quantitative processing of the applied instruments. Technology was used for determining problems and potentialities of advanced education. Conclusions: The application of the aforementioned technology allowed characterizing the current state of professional performance in Human Histology of the specialist being trained in Pathological Anatomy, which revealed deficiencies and difficulties in the dimensions theoretical-practical knowledge in Human Histology, human behavior, as well as ethical and bioethical behavior. The methodological triangulation applied to the results of the instruments contributed to the identification of the inventory of problems and potentialities(AU)

Características clínico-patológicas de las lesiones malignas del tracto urinario inferior / Clinicopathological features of malignant lesions of the lower urinary tract / Características clínico-patológicas de lesões malignas do trato urinário inferior

RESUMEN Introducción: El cáncer de vejiga es un tumor mucho más frecuente de lo que a veces nos transmiten las estadísticas o los medios de comunicación. Ocupa el noveno lugar en cuanto al número de diagnósticos de cáncer a nivel mundial y se reporta aproximadamente cinco veces más frecuente en varones que en mujeres. Objetivo: Describir las características clínico-patológicas de los tumores malignos del tracto urinario inferior. Método: Se realizó un estudio descriptivo y transversal de 186 pacientes con tumores malignas del tracto urinario inferior diagnosticados anatomo-patológicamente en el Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres", de Santiago de Cuba, entre los años 2017 al 2020. Una vez recopilados los datos se procesaron mediante el sistema estadístico SPSS, en su versión 21.0. Resultados: En la serie la mayoría de los afectados fueron hombres entre los 60 y 79 años de edad, siendo más frecuente en el sexo masculino. Predominaron los carcinomas uroteliales con el 96,4 % del total en su variedad papilar y de alto grado de malignidad. Conclusiones: Los tumores malignos del tracto urinario inferior son un problema de salud de baja frecuencia cuya trascendencia es la afectación individual a quien lo padece, y su comportamiento clínico patológico, en sentido general, fue similar a lo reportado por la literatura nacional e internacional, salvo pequeñas y puntuales diferencias relativo a los síntomas, el diagnóstico histológico, en parte, y el grado de malignidad de las lesiones.

ABSTRACT Introduction: Bladder cancer is a more common tumor that sometimes the statistics database or media conveyed to us. It ranks ninth concerning cancer diagnoses worldwide and it is reported to be approximately five times more frequent in males than in females. Objective: To describe the clinicopathologic features of malignant lower urinary tract tumors. Method: A descriptive and cross-sectional study involving a total of 186 patients was conducted. Anatomical and pathological diagnoses were carried out to all patients with malignant lower urinary tract tumor at the Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" in Santiago de Cuba, from 2017 throughout 2020. Once the data were collected, they were processed using the SPSS statistical system, version 21.0. Results: Most affected patients with lower urinary tract tumor had an average age of 60 to 70, arising most frequently in males. The 96.4 % of the total of the patients were diagnosed with urothelial carcinomas (predominant), described in its papillary variety and the high degree of malignant transformation. Conclusions: Malignant lower urinary tract tumors are health problems labeled as the low frequency which differ in their transformation according to the patient. The clinical pathological behavior of the tumor, in a general sense, was similar to that reported in the national and international literature, except for small and pointed differences regarding symptoms, histological diagnosis, and the degree of the lesions´ malignant transformation.

RESUMO Introdução: O câncer de bexiga é um tumor mais comum do que às vezes o banco de dados de estatísticas ou a mídia veiculada por nós. Ele ocupa o nono lugar em diagnósticos de câncer em todo o mundo e é relatado ser aproximadamente cinco vezes mais frequente em homens do que em mulheres. Objetivo: Descrever as características clínico-patológicas dos tumores malignos do trato urinário inferior. Método: Foi realizado um estudo descritivo e transversal envolvendo um total de 186 pacientes. Os diagnósticos anatômicos e patológicos foram realizados a todos os pacientes com tumor maligno do trato urinário inferior no Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" em Santiago de Cuba, de 2017 a 2020. Uma vez coletados os dados, eles foram processados ​​no SPSS sistema estatístico, versão 21.0. Resultados: A maioria dos pacientes afetados com tumor do trato urinário inferior tinha uma idade média de 60 a 70 anos, surgindo mais frequentemente no sexo masculino. 96,4% do total dos pacientes foram diagnosticados com carcinomas uroteliais (predominantes), descritos em sua variedade papilar e alto grau de transformação maligna. Conclusões: Os tumores malignos do trato urinário inferior são problemas de saúde rotulados como de baixa frequência e que diferem em sua transformação de acordo com o paciente. O comportamento clínico-patológico do tumor, de um modo geral, foi semelhante ao relatado na literatura nacional e internacional, exceto por pequenas e pontuadas diferenças quanto à sintomatologia, ao diagnóstico histológico e ao grau de transformação maligna das lesões.

Sistema informático para la gestión del conocimiento en los departamentos de anatomía patológica / Knowledge Management Computer System for Departments of Pathological Anatomy

Cuba posee uno de los índices de autopsia más elevados del mundo, sin embargo, la información generada durante este proceso no se aprovecha al máximo, debido al crecimiento acelerado de los datos. El análisis de los resultados de la autopsia genera múltiples beneficios mayormente orientados a mejorar la calidad del diagnóstico médico. En este contexto el mayor desafío es la obtención del conocimiento implícito en los datos; factible con la incorporación de las nuevas Tecnologías de la Información y las Comunicaciones. En este trabajo se presenta el sistema informático SIRCAP el cual fue desarrollado con el objetivo de gestionar el conocimiento generado en los departamentos de Anatomía Patológica pertenecientes a la red hospitalaria cubana. El sistema obtenido garantiza con su generalización, el estudio de un mayor número de casos en apoyo a la toma de decisiones. Al mismo tiempo promueve la codificación de los diagnósticos según los más recientes estándares de terminología impulsados por la Organización Mundial de la Salud. La solución desarrollada, facilita el proceso de evaluación de la calidad en la atención médica, a partir del análisis y clasificación de la correlación clinicopatológica. Posibilita la configuración y aplicación reglas de control interno sobre los diagnósticos contribuyendo a elevar la calidad de los datos almacenados. Permite la creación de un amplio conjunto de reportes estadísticos sobre los datos, los cuales podrán ser empleados como soporte para la toma de decisiones, además de contribuir con el descubrimiento y explicación de nuevas enfermedades, manifestaciones inusuales de enfermedades conocidas y complicaciones terapéuticas(AU)

Cuba has one of the highest autopsy rates in the world, however, the information generated during this process is not used to the maximum, due to the accelerated growth of the data. The analysis of the results of the autopsy generates multiple benefits mainly aimed at improving the quality of medical diagnosis. In this context, the greatest challenge is obtaining the knowledge implicit in the data; feasible with the incorporation of the new Information and Communications Technologies. This work presents the SIRCAP computer system, which was developed with the aim of managing the knowledge generated in the departments of Pathological Anatomy belonging to the Cuban hospital network. The system obtained guarantees with its generalization, the study of a greater number of cases in support of decision making. At the same time, it promotes the coding of diagnoses according to the most recent terminology standards promoted by the World Health Organization. The developed solution facilitates the process of quality assessment in medical care, based on the analysis and classification of the clinic-pathological correlation. It allows the configuration and application of internal control rules over the diagnostics contributing to raise the quality of the stored data. It allows the creation of a wide set of statistical reports on data, which can be used as support for decision making, in addition to contributing to the discovery and explanation of new diseases, unusual manifestations of known diseases and therapeutic complications(AU)

Estudio de las biopsias de muertes maternas en un hospital universitario de alta complejidad en Santander, Colombia / Biopsies Study of Maternal Deaths in a High Complexity University Hospital in Santander, Colombia

Introducción: La incidencia de muerte materna es un ítem indispensable para la medición de la calidad y cobertura en salud. Objetivo: Describir los hallazgos anatomopatológicos de 31 casos de muerte materna ocurridos en el área metropolitana de una ciudad intermedia de Colombia entre 2005-2018, así como establecer sus características sociodemográficas. Métodos: Se realiza estudio retrospectivo descriptivo de corte transversal basado en la revisión de 3 500 protocolos de autopsias efectuadas por el Departamento de Patología de la Universidad Industrial de Santander adscrito al Hospital Universitario de Santander, Colombia, entre enero 2005 y marzo 2018, se extractan aquellos en los cuales el diagnóstico relacionado sea de muerte materna y muerte materna tardía, tomando como referencia la definición dictada por la Organización Mundial de la Salud. Resultados: El rango de edad estuvo comprendido entre 14 y 40 años, promedio 26,7 años y mediana de 26 años. En 9 casos (29 por ciento) se reportó un nivel educativo básico primario y en los restantes (71 por ciento), básico secundario. No existieron casos con estudios universitarios. El rango de edad gestacional estuvo entre 11 y 39 semanas (promedio 31,4 semanas), y 8 casos correspondieron a primigestas (25,8 por ciento) Existieron 29 casos de muerte materna temprana y dos de muerte materna tardía; se detectaron 10 casos con causas obstétricas directas y 21 causas indirectas, de los cuales, 14 fueron de origen infeccioso, siendo el dengue la causa más frecuente. Conclusiones: En nuestro medio, los procesos infecciosos no ginecobstétricos ocasionan la mayor cantidad de casos de muerte materna, siendo el dengue la principal de estas causas(AU)

Introduction: The incidence of maternal death is an essential item for assessing quality and coverage in health. Objective: To describe the histological findings of 31 cases of maternal death that occurred in the metropolitan area of an intermediate city of Colombia from 2005-2018, as well as to establish their sociodemographic characteristics. Methods: A retrospective cross-sectional descriptive study was carried out based on the review of 3 500-autopsy protocols carried out by the Department of Pathology of Santander Industrial University, which were assigned to Santander University Hospital in Colombia, between January 2005 and March 2018. We mined those in which the related diagnosis is maternal death and late maternal death, taking as reference the definition stablished by the World Health Organization. Results: The age ranged 14 to 40 years, average 26.7 years and media 26 years. Nine cases (29 percent), reported primary basic education level and the remaining (71 percent), reported secondary basic education. There were no cases reported to have university studies. The gestational age ranged 11 to 39 weeks (average 31.4 weeks), and eight cases corresponded to primigravida (25.8 percent). There were 29 cases of early maternal death and two of late maternal death; 10 cases were detected to have direct obstetric causes and 21 indirect causes, 14 out of which had infectious causes. dengue was the most frequent cause. Conclusions: In our environment, infectious non-gynecological processes cause the highest number of maternal deaths. Dengue is the main cause(AU)

Ética médica en la práctica anatomopatológica / Medical ethics in anatomical-pathological practice

RESUMEN El objetivo del presente estudio está dirigido a exponer particularidades éticas del trabajo anatomopatológico a la luz de la realidad histórico social. Se emplean métodos teóricos y empíricos y a partir del análisis documental se opera con referentes en los enfoques contemporáneos. El estudio de aspectos generales referidos a la moral y a la ética permitió acceder a definiciones, bases legales y evolución histórica, a la vez que se profundiza en su repercusión en el sector salud y se desarrollan las peculiaridades del trabajo anatomopatológico desde sus manifestaciones en la actividad asistencial, docente e investigativa. Se concluye que los principios éticos generales de la conducta profesional y médica son aplicables al trabajo anatomopatológico en todas sus esferas; al igual que los de la bioética.

ABSTRACT The objective of the present study is directed to exhibit ethical peculiarities of the anatomical-pathological work in view of the historical-social reality. Theoretical and empirical methods are used and from the documentary analysis it occurs with modality in the contemporary approaches. The study of general aspects referred to the morality and to the ethics allowed to gain access to definitions, legal bases and historical evolution, simultaneously that deepens in its aftereffect in the sector health and the peculiarities of the anatomical-pathological work develop from its declarations in the welfare, teaching and investigative activity. One concludes that the general ethical beginning of the professional and medical conduct is applicable to the anatomical-pathological work in all its spheres; as those of the bioethics.

Correlación entre resultados de citología y anatomía patológica en nódulos tiroideos intervenidos quirúrgicamente / Correlation between cytology results and pathological anatomy in surgically treated thyroid nodules / Correlação entre resultados de citologia eanatomia patológica em nódulos tireoidianos tratados cirurgicamente

INTRODUCCIÓN: Los nódulos tiroideos son habituales y pueden ser detectados por ultrasonido hasta en el 60% de la población general. La punción aspiración con aguja fina (PAAF) es una herramienta imprescindible en la actualidad para evaluar nódulos tiroideos. El objetivo de este estudio es describir la correlación entre la citología de un nódulo tiroideo y la histología luego de la exéresis quirúrgica, y así evaluar el valor diagnóstico de la PAAF. MATERIAL Y MÉTODO: Estudio observacional, descriptivo y retrospectivo. Se incluyeron todos los pacientes que fueron sometidos a tiroidectomía en el período comprendido entre enero de 2014 y diciembre de 2016. Se excluyeron a los pacientes cuya intervención estuvo motivada por un mal manejo del perfil hormonal, refractario al tratamiento médico, ya que no presentaban nódulos tiroideos, y los pacientes de edad pediátrica...

INTRODUCTION: Thyroid nodules are common and can be detected by ultrasound in up to 60% of the general population. Fine-needle aspiration citology (FNAC) is currently an essential tool for evaluating thyroid nodules. The aim of this study is to describe the correlation between cytology of a thyroid nodule and histology after surgical excision, and thus to evaluate the diagnostic value of FNAC. MATERIAL AND METHOD: Observational, descriptive and retrospective study. All patients who underwent thyroidectomy in the period between January 2014 and December 2016 were included. Patients whose intervention was motivated by poor hormonal profile management, refractory to medical treatment, were excluded because they had no nodules thyroid, and pediatric patients…

INTRODUÇÃO: Os nódulos tireoidianos são comuns e podem ser detectados por ultrasom em até 60% da população em geral. A aspiração com agulha fina (FNAP) é atualmente uma ferramenta essencial para avaliar os nódulos tireoidianos. O objetivo deste estudo é descrever a correlação entre citologia de um nódulo tireoidiano e histologia após a excisão cirúrgica, e assim avaliar o valor diagnóstico de FNAB. MATERIAL E MÉTODO: Estudo observacional, descritivo e retrospectivo. Todos os pacientes que foram submetidos a tireoidectomia no período entre janeiro de 2014 e dezembro de 2016. Foram incluídos os pacientes cuja intervenção foi motivada por uma má gestão do perfil hormonal, refratária ao tratamento médico, porque não possuíam nódulos tireóide e pacientes pediátricos...

Vínculos históricos entre la medicina interna y la anatomía patológica / Historical relations between Internal Medicine and Pathological Anatomy

La relación de discrepancia y coincidencia de las causas de muerte entre el diagnóstico clínico y anatomopatológico constituye de forma indirecta un indicador de calidad de la atención médica. Son múltiples los ejemplos de enfermedades descubiertas o esclarecidas gracias a la autopsia, que tiene en la correlación clinicopatológica un basamento fundamental. Se estableció como objetivo de investigación describir los principales vínculos históricos entre las especialidades de medicina interna y anatomía patológica, que tienen como enlace esencial la correlación clínico patológica, atendiendo a que no puede existir contradicción antagónica entre enfermo y enfermedad; la medicina interna y la anatomía patológica no pueden verse aisladas ni separadas.

The difference and similarity relationship of death causes between the clinical and anatomy-pathological diagnosis is, indirectly, a medical care quality indicator. Thanks to autopsy, which has the clinical-pathological correlation as a main basis, numerous diseases have been discovered or clarified. Discovering the main historical relations between Internal Medicine and Pathological Anatomy specialties was established as the objective of the research. These specialties have the clinical-pathological correlation as a main link, taking into account that there cannot be a conflicting contradiction between the sick and the disease; Internal Medicine and Pathological Anatomy cannot be seen in an isolated or separate way.

Síndrome hemorrágica pulmonar em cão associada à leptospirose / Pulmonary haemorrhagic syndrome in dog associated with leptospirosis

Background: Leptospirosis is probably the most widespread and prevalent zoonosis in the world, being classified as an emerging infectious disease for humans and dogs. Sporadically, dogs may present with cough and dyspnea, indicative of pulmonary involvement, associated with interstitial pneumonia and pulmonary hemorrhage with alveolar consolidation. Such changes stem from pulmonary haemorrhagic syndrome, which has emerged as a fatal complication, being documented in some areas in Europe and little described in North America. In this sense, the present study aims to report pulmonary hemorrhagic syndrome in a dog with leptospirosis.Case: A dog with no defined breed, aged 45 days, weighing 2.2 kg, with a history of apathy, anorexia, jaundice, hematochezia and vocalisation with a two day evolution was seen. Physical examination revealed a rectal temperature of 37.2°C, icteric mucosa, capillary filling time of two seconds, respiratory rate of 80 movements per minute and heart rate of 140 beats per minute, dehydration rate estimated at 8%, prostration, adequate body score, normal cardiac sounds and clean lung fields, in addition to petechiae in the abdominal region, whose palpation evidenced the presence of fluid in intestinal loops. The blood sample sent to the macroscopic serum agglutination was reagent for the serovar Icterohaemorragiae, titration of 200. Blood count revealed leukocytosis due to neutrophilia, with left-sided deviation, eosinopenia, presence of rare hypersegmentated neutrophils, rare toxic neutrophils, mild cytoplasmic basophilia and rare reactive lymphocytes. Platelet estimation demonstrated thrombocytopenia. No haemoparasites were seen. Regarding the biochemical evaluation, there were changes in liver enzymes and markers of renal failure. Fluid therapy was used with 0.9% NaCl solution, 5 mg/ kg doxycycline intravenously every 12 h and nasogastric probe for administration of nutritional support...(AU)

Síndrome hemorrágica pulmonar em cão associada à leptospirose / Pulmonary haemorrhagic syndrome in dog associated with leptospirosis

Background: Leptospirosis is probably the most widespread and prevalent zoonosis in the world, being classified as an emerging infectious disease for humans and dogs. Sporadically, dogs may present with cough and dyspnea, indicative of pulmonary involvement, associated with interstitial pneumonia and pulmonary hemorrhage with alveolar consolidation. Such changes stem from pulmonary haemorrhagic syndrome, which has emerged as a fatal complication, being documented in some areas in Europe and little described in North America. In this sense, the present study aims to report pulmonary hemorrhagic syndrome in a dog with leptospirosis.Case: A dog with no defined breed, aged 45 days, weighing 2.2 kg, with a history of apathy, anorexia, jaundice, hematochezia and vocalisation with a two day evolution was seen. Physical examination revealed a rectal temperature of 37.2°C, icteric mucosa, capillary filling time of two seconds, respiratory rate of 80 movements per minute and heart rate of 140 beats per minute, dehydration rate estimated at 8%, prostration, adequate body score, normal cardiac sounds and clean lung fields, in addition to petechiae in the abdominal region, whose palpation evidenced the presence of fluid in intestinal loops. The blood sample sent to the macroscopic serum agglutination was reagent for the serovar Icterohaemorragiae, titration of 200. Blood count revealed leukocytosis due to neutrophilia, with left-sided deviation, eosinopenia, presence of rare hypersegmentated neutrophils, rare toxic neutrophils, mild cytoplasmic basophilia and rare reactive lymphocytes. Platelet estimation demonstrated thrombocytopenia. No haemoparasites were seen. Regarding the biochemical evaluation, there were changes in liver enzymes and markers of renal failure. Fluid therapy was used with 0.9% NaCl solution, 5 mg/ kg doxycycline intravenously every 12 h and nasogastric probe for administration of nutritional support...

La cardiología en la obra anatomopatológica de G.B. Morgagni / Cardiology in the Morgagni's anatomo pathological work

En el siglo XVIII, bajo el influjo del <

In the XVIII century, under the influence of the <

[Cardiology in the Morgagni's anatomo pathological work]. / La cardiología en la obra anatomopatológica de G.B. Morgagni.

In the XVIII century, under the influence of the "systematic spirit", characteristic of the Enlightenment age, pathological anatomy was systematized in the Morgagni's fundamental treatise De sedibus et causis morborum per anatomen indagatis, published as letters in 1761. Certain biographical data of the author are reported here as well as some his more important contributions to cardiology such as the Morgagni's, Adams', Stokes' syndrome. His points of view on sudden death and his observations on post-infarct myocardial rupture, are related also. In his global evaluation of these facts, the speculative approach always predominates. Indeed, in these anatomist's works, we find a good example of the application of epistemologic principles to the medical field.

Aportes de Giovanni Battista Morgagni al desarrollo de la neurocirugía / Giovanni Battista Morgagni contributions tothe development of neurosurgery

Introducción: El estudio de la anatomía humana se convirtió en el eje principal del desarrollo en la medicina de los siglos XVI y XVII. Sin embargo, fue el gran anatomista italiano Giovanni Battista Morgagni que con su obra marco el inicio de la anatomía patológica moderna, así como el punto de partida de la base científica anatomoclínica de muchas especialidades donde se encuentra la neurocirugía. Conclusiones: El estudio de la Anatomía patológica sirvió de base para el conocimiento y desarrollo en la neurocirugía moderna.

Introduction: The study of human anatomy became the main axis of development in medicine from the XVI and XVII centuries. However, it was the great Italian anatomist Giovanni Battista Morgagni with his work marked the beginning of modern pathological anatomy, as well as the starting point of the scientific basis of many specialties anatomic where neurosurgery. Conclusions: The study of pathology was the basis for knowledge and development in modern neurosurgery.

Revisión de indicación de tiroidectomía y su correlación con la anatomía patológica / Review of Indication for Thyroidectomy and its Correlation with the Pathological Anatomy

Objetivo: 1. Determinar el porcentaje de patología tiroidea maligna en tiroidectomía en un hospital interzonal de la provincia de Buenos Aires. 2. Evaluar la indicación de tiroidectomías por motivos clínicos y/o citológicos, relacionándolos con la anatomía patológica. Materiales y Métodos: Evaluamos retrospectivamente las historias clínicas de 214 pacientes sometidos a cirugía tiroidea desde junio de 2004 a junio de 2010, correlacionando la indicación quirúrgica con la anatomía patológica. Para su análisis se dividieron a los mismos en dos grupos: 1) aquellos a los que se les indicó tiroidectomía utilizando criterios clínicos como bocio de gran tamaño, endotoráxico, crecimiento rápido del nódulo, fijeza, etc., presentando los mismos punciones tiroideas (PAF) benignas o insatisfactorias (n = 152), 2) aquellos a los que se les indicó tiroidectomía por presentar citología maligna o sospechosa de malignidad (n = 62). Resultados: De los 214 pacientes evaluados, 203 fueron mujeres y 11 varones, con una edad media de 43,3 años (17-64 años); realizándose tiroidectomía total en 117 casos y subtotal en 97. El 98 % de los pacientes (n = 210), tenían punciones prequirúrgicas, de las cuales el 24,7 %, fueron insatisfactorias. Presentaron hipocalcemia transitoria 17 pacientes (7,9 %), definitiva 3 (1,4 %) y parálisis recurrencial unilateral 3 (1,4 %). El 21,5 % (n = 46) del total de casos presentó patología maligna. De los 152 pacientes operados por criterio clínico presentaron malignidad el 10,5 % (n = 16); mientras que los operados por sospechas de malignidad por PAF (n = 62) presentaron carcinoma el 48,4 % (n = 30). De los pacientes con bocio nodular operados por criterio clínico teniendo PAF insatisfactorias (n = 50), presentaron carcinoma 14 pacientes (28 %). Conclusiones: Del total de pacientes tiroidectomizados hemos hallado un alto porcentaje de patología benigna (78,5 %). De los pacientes con bocio nodular operados por criterio clínico, con punciones insatisfactorias, el 28 % fueron malignos. Consideramos que es fundamental utilizar el criterio citológico al momento de indicar la tiroidectomía; y ante un alto porcentaje de citologías insatisfactorias, sería de importancia revisar la metodología diagnóstica en nuestro lugar de trabajo.(AU)

Objective: 1. To determine the percentage of malignant thyroid pathology in thyroidectomy in an Hospital inside the province of Buenos Aires. 2. To evaluate the indication for thyroidectomy due to medical and/or cytological reasons relating them to the pathological anatomy. Materials and Methods: We retrospectively evaluated the medical records of 214 patients who had a thyroid surgery from June 2004 to June 2010, relating the surgical indication to the pathological anatomy. For its analysis, the patients were divided into two groups: 1) those ones who were treated as thyroidectomy using medical criteria such as: a large endothoracic goiter, a fast growing nodule, firmness, etc. These patients showed negative or unsatisfactory thyroid cytology (n = 152); 2) those ones who were treated as thyroidectomy because they showed a cytology suspected to be malignant (n = 62). Results: From 214 patients evaluated, 203 were women and 11 men, with an average age of 43.3 years old (17-64 years old); a total thyroidectomy was carried out in 117 cases and a subtotal one in 97 cases. Of all the patients 98 % (n = 210) had thyroid fine needle aspiration (FNA), 24.7 % of which were unsatisfactory. Seventeen patients had temporary hypoparathyroidism (7.9 %), 3 patients had permanent one (1.4 %) and 3 patients had unilateral vocal cord paralysis (1.4 %). Of all the cases 21.5 % (n = 46) showed malignant pathology. From 152 patients who had surgery due to medical criteria, 10.5 % (n=16) showed malignancy; whereas the patients who had surgery for FNA (n = 62) suspected to be malignant showed thyroid cancer in 48.4 % (n = 30). From the patients with nodular goiter operated due to medical criteria having unsatisfactory FNA (n = 50), 14 patients had carcinoma (28 %). Conclusions: From the total of patients with thyroidectomy we have found a high percentage of benign pathology (78.5 %). From the patients with nodular goiter who were operated due to medical criteria, with unsatisfactory cytology, 28 % were malignant. We consider that it is essential to use cytological criteria upon the thyroidectomy indication however, if there were high percentage of unsatisfactory cytology, it would be necessary to check the diagnostic methodology where we work.(AU)

Revisión de indicación de tiroidectomía y su correlación con la anatomía patológica / Review of Indication for Thyroidectomy and its Correlation with the Pathological Anatomy

Objetivo: 1. Determinar el porcentaje de patología tiroidea maligna en tiroidectomía en un hospital interzonal de la provincia de Buenos Aires. 2. Evaluar la indicación de tiroidectomías por motivos clínicos y/o citológicos, relacionándolos con la anatomía patológica. Materiales y Métodos: Evaluamos retrospectivamente las historias clínicas de 214 pacientes sometidos a cirugía tiroidea desde junio de 2004 a junio de 2010, correlacionando la indicación quirúrgica con la anatomía patológica. Para su análisis se dividieron a los mismos en dos grupos: 1) aquellos a los que se les indicó tiroidectomía utilizando criterios clínicos como bocio de gran tamaño, endotoráxico, crecimiento rápido del nódulo, fijeza, etc., presentando los mismos punciones tiroideas (PAF) benignas o insatisfactorias (n = 152), 2) aquellos a los que se les indicó tiroidectomía por presentar citología maligna o sospechosa de malignidad (n = 62). Resultados: De los 214 pacientes evaluados, 203 fueron mujeres y 11 varones, con una edad media de 43,3 años (17-64 años); realizándose tiroidectomía total en 117 casos y subtotal en 97. El 98 % de los pacientes (n = 210), tenían punciones prequirúrgicas, de las cuales el 24,7 %, fueron insatisfactorias. Presentaron hipocalcemia transitoria 17 pacientes (7,9 %), definitiva 3 (1,4 %) y parálisis recurrencial unilateral 3 (1,4 %). El 21,5 % (n = 46) del total de casos presentó patología maligna. De los 152 pacientes operados por criterio clínico presentaron malignidad el 10,5 % (n = 16); mientras que los operados por sospechas de malignidad por PAF (n = 62) presentaron carcinoma el 48,4 % (n = 30). De los pacientes con bocio nodular operados por criterio clínico teniendo PAF insatisfactorias (n = 50), presentaron carcinoma 14 pacientes (28 %). Conclusiones: Del total de pacientes tiroidectomizados hemos hallado un alto porcentaje de patología benigna (78,5 %). De los pacientes con bocio nodular operados por criterio clínico, con punciones insatisfactorias, el 28 % fueron malignos. Consideramos que es fundamental utilizar el criterio citológico al momento de indicar la tiroidectomía; y ante un alto porcentaje de citologías insatisfactorias, sería de importancia revisar la metodología diagnóstica en nuestro lugar de trabajo.

Objective: 1. To determine the percentage of malignant thyroid pathology in thyroidectomy in an Hospital inside the province of Buenos Aires. 2. To evaluate the indication for thyroidectomy due to medical and/or cytological reasons relating them to the pathological anatomy. Materials and Methods: We retrospectively evaluated the medical records of 214 patients who had a thyroid surgery from June 2004 to June 2010, relating the surgical indication to the pathological anatomy. For its analysis, the patients were divided into two groups: 1) those ones who were treated as thyroidectomy using medical criteria such as: a large endothoracic goiter, a fast growing nodule, firmness, etc. These patients showed negative or unsatisfactory thyroid cytology (n = 152); 2) those ones who were treated as thyroidectomy because they showed a cytology suspected to be malignant (n = 62). Results: From 214 patients evaluated, 203 were women and 11 men, with an average age of 43.3 years old (17-64 years old); a total thyroidectomy was carried out in 117 cases and a subtotal one in 97 cases. Of all the patients 98 % (n = 210) had thyroid fine needle aspiration (FNA), 24.7 % of which were unsatisfactory. Seventeen patients had temporary hypoparathyroidism (7.9 %), 3 patients had permanent one (1.4 %) and 3 patients had unilateral vocal cord paralysis (1.4 %). Of all the cases 21.5 % (n = 46) showed malignant pathology. From 152 patients who had surgery due to medical criteria, 10.5 % (n=16) showed malignancy; whereas the patients who had surgery for FNA (n = 62) suspected to be malignant showed thyroid cancer in 48.4 % (n = 30). From the patients with nodular goiter operated due to medical criteria having unsatisfactory FNA (n = 50), 14 patients had carcinoma (28 %). Conclusions: From the total of patients with thyroidectomy we have found a high percentage of benign pathology (78.5 %). From the patients with nodular goiter who were operated due to medical criteria, with unsatisfactory cytology, 28 % were malignant. We consider that it is essential to use cytological criteria upon the thyroidectomy indication however, if there were high percentage of unsatisfactory cytology, it would be necessary to check the diagnostic methodology where we work.

Angiomiolipoma hepático / Hepatic angiomyolipoma

O angiomiolipoma, tumor mesenquimal benigno, ocorre com mais frequência no rim, sendo que apenas 5 a 10% têm como localização o fígado. É composto por vasos sanguíneos, tecido adiposo e músculo liso. Em 60% dos pacientes, a lesão é assintomática, sendo comumente um achado ocasional em exames de imagem. Quando sintomas estão presentes, estes são: desconforto abdominal, massa palpável no hipocôndrio direito e mal- estar. O angiomiolipoma de fígado é um tumor de difícil diagnóstico, sendo confirmado somente após a análise anatomopatológica. Tem a sua importância como diagnóstico diferencial de outras neoplasias mais comuns, especialmente o carcinoma hepatocelular. O caso relatado chama a atenção para esta condição e compara os achados com os descritos na literatura.

The angiomyolipoma, a benign mesenchymal tumor, occurs most frequently in the kidney, with only 5-10% appearing in the liver. It is composed of blood vessels, adipose tissue and smooth muscle. In 60% of patients the lesion is asymptomatic and is usually a chance finding in imaging studies. If present, symptoms are: abdominal discomfort, palpable mass in the right hypochondrium, and malaise. Angiomyolipoma of the liver is a tumor of difficult diagnosis, which is confirmed only after a histopathological analysis. It is important as a differential diagnosis of other more common malignancies, especially hepatocellular carcinoma. The reported case draws attention to this condition and compares the findings with those described in the literature.

Avaliação das condições ambientais no laboratório de anatomia patológica de um hospital universitário no município do Rio de Janeiro / Assessment of environmental conditions in the pathological anatomy laboratory of a university hospital located in Rio de Janeiro

INTRODUÇÃO: Em laboratórios de anatomia patológica existem diversos tipos de riscos ambientais e ocupacionais. Tais riscos podem estar associados a acidentes do trabalho ou doenças ocupacionais. OBJETIVOS: Identificar e avaliar os riscos do processo de trabalho, estimulando a percepção dos mesmos pelos trabalhadores. MÉTODOS: Foi realizado o levantamento dos processos, fluxos de serviços, equipamentos, instalações, produtos, materiais, resíduos, equipes de trabalho e atividades dos trabalhadores. A seguir foram realizadas as medições dos agentes, elaborando-se a representação gráfica do mapa de riscos. RESULTADOS: Observou-se a presença de riscos químicos, físicos, biológicos, acidentários e inadequações ergonômicas. CONCLUSÃO: Os riscos de natureza química e biológica foram identificados como principais no processo de trabalho. Também foi verificada a necessidade de reformas e maiores investimentos na aquisição de equipamentos de proteção individual e coletiva visando à melhoria das condições de trabalho. A adesão a normas de biossegurança e a inserção de programas de educação continuada são indispensáveis no processo de redução dos riscos ambientais e ocupacionais.

BACKGROUND: In pathological anatomy laboratories, there are several kinds of environmental and occupational hazards, which can be associated with work accidents and occupational diseases. OBJECTIVES: To identify and assess work process risks in order to raise workers' awareness. METHODS: It was carried out an investigation into work processes, flow of services, equipment, site, products, materials, residues, work teams and workers' activities. Subsequently, the agents were assessed and the graphic representation of the risk map was developed. RESULTS: The presence of chemical, physical, biological and accidental risks and ergonomic inadequacies were observed. CONCLUSION: Biological and chemical agents were identified as the main risks in the work process. Furthermore, the necessity of refurbishment and additional investments in the purchase of individual and collective protection equipment was noticed. The adherence to biosecurity protocols and the introduction of continuing education programs are invaluable to reduce occupational and environmental hazards.

Estudio morfopatológico de 101 corazones portadores de defecto septal interventricular / Morphopathological study of 101 hearts with interventricular septal defect

Las diversas denominaciones y clasificaciones de los defectos septales ventriculares (DSV) motivó la realización de este estudio con el propósito de contribuir a la adopción de una terminología común y de una clasificación en la que se integren criterios morfológicos, topográficos y quirúrgicos. Se estudiaron 101 defectos septales ventriculares con el método secuencial segmentario de la colección patológica del Instituto Nacional de Cardiología "Ignacio Chávez". El septum ventricular (SV) se dividió en cuatro áreas, tres musculares (entrada, trabecular y salida) y una perimembranosa. Los DSV se describieron y agruparon según su localización y el tejido de sus bordes y se relacionaron con las válvulas cardíacas y el sistema de conducción. Los DSV fueron: de tipo perimembranoso (77 = 77.23%) con los subtipos de acuerdo con las extensiones musculares: de entrada (31 = 39.75%), entrada y trabecular (25 = 32.05%) con las tres extensiones (17 = 21.80%), entrada y salida (2 = 2.56%), salida (1 = 1.28%), trabecular (1=1.28%) y a las porciones trabecular y de salida (1 = 1.28%). DSV trabeculares (9 = 8.91%), de la porción de salida (7 = 6.93%), de entrada (3 = 3.97%) y el mixto (4 = 3.96%). La clasificación topográfica estructural permite ubicar el sitio del defecto septal, determinar el tejido de sus bordes y sus relaciones con las válvulas cardíacas y el sistema de conducción. El conocimiento de la anatomía quirúrgica de esta cardiopatía es de gran utilidad para el cirujano y constituye la base para la interpretación precisa de la imagenología diagnóstica. El retardo en el crecimiento de los esbozos embrionarios que conforman el tabique ventricular y la falta de compactación septal son mecanismos patogenéticos de estos defectos.

The various terms and classifications of ventricular septal defects (VSD) stimulated us to perform the present study with the purpose of adopting a common terminology and classification in which morphologic, topographic and surgical criteria concur. One hundred and one VSD where studied by means of the sequential segmental approach from the pathologic collection of the Instituto Nacional de Cardiología "Ignacio Chávez". The ventricular septum (VS) was divided in four areas, three muscular (inlet, trabecular and outlet) and one perimembranous. The VSD where described and cathegorized according to their tissue borders, localization and relationship with the cardiac valves and the conduction tissue. The results were: Perimembranous type (77 = 77.23%), with the subtypes according to the muscular extensions: inlet (31 = 39.75%), inlet and trabecular (25 = 32.05%), with three extensions (17 = 21.80%), inlet and outlet (2 = 2.56%), outlet (1 = 1.28%), trabecular (1 =1.28%), trabecular and outlet (1 = 1.28%); trabecular (9 = 8.91%), outlet (7 = 6.93%), inlet (3 = 3.97%) and mixed types (4 = 3.96%). The topographic-structural classification permits the localization of VSD, as well as to specify their border's tissue and their relationship with the cardiac valves and conduction system. Knowledge of the surgical anatomy of VSD is useful to the surgeon, and constitutes the basis to interpret with precision the diagnostic imaging studies. Delay in the development of the embryonic primordia of the VS and the absence of septal consolidation are the pathogenic mechanisms involved.

Sudden Death of Citrus in Brazil: A Graft-Transmissible Bud Union Disease.

Citrus Sudden Death (CSD), a new, graft-transmissible disease of sweet orange and mandarin trees grafted on Rangpur lime rootstock, was first seen in 1999 in Brazil, where it is present in the southern Triângulo Mineiro and northwestern São Paulo State. The disease is a serious threat to the citrus industry, as 85% of 200 million sweet orange trees in the State of São Paulo are grafted on Rangpur lime. After showing general decline symptoms, affected trees suddenly collapse and die, in a manner similar to trees grafted on sour orange rootstock when affected by tristeza decline caused by infection with Citrus tristeza virus (CTV). In tristeza-affected trees, the sour orange bark near the bud union undergoes profound anatomical changes. Light and electron microscopic studies showed very similar changes in the Rangpur lime bark below the bud union of CSD-affected trees: size reduction of phloem cells, collapse and necrosis of sieve tubes, overproduction and degradation of phloem, accumulation of nonfunctioning phloem (NFP), and invasion of the cortex by old NFP. In both diseases, the sweet orange bark near the bud union was also affected by necrosis of sieve tubes, and the phloem parenchyma contained characteristic "chromatic" cells. In CSD-affected trees, these cells were seen not only in the sweet orange phloem, but also in the Rangpur lime phloem. Recent observations indicated that CSD affected not only citrus trees grafted on Rangpur lime but also those on Volkamer lemon, with anatomical symptoms similar to those seen in Rangpur lime bark. Trees on alternative rootstocks, such as Cleopatra mandarin and Swingle citrumelo, showed no symptoms of CSD. CSD-affected trees did recover when they were inarched with seedlings of these rootstocks, but not when inarched with Rangpur lime seedlings. These results indicate that CSD is a bud union disease. In addition, the bark of inarched Rangpur lime and Volkamer lemon seedlings showed, near the approach-graft union, the same anatomical alterations as the bud union bark from the Rangpur lime rootstock in CSD-affected trees. The dsRNA patterns from CSD-affected trees and unaffected trees were similar and indicative of CTV. CSD-affected trees did not react by immunoprinting-ELISA using monoclonal antibodies against 11 viruses. No evidence supported the involvement of viroids in CSD. The potential involvement of CTV and other viruses in CSD is discussed.