bluuebunny/crossref_metadata_2025 huggingface dataset:
Relevance of micrometastases detected by reverse transcriptase-polymerase chain reaction for melanoma recurrence: systematic review and meta-analysis
Authors: Silva Allisson Monteiro da , Oliveira Filho Renato Santos de , Ferreira Lydia Masako , Saconato Humberto
Published: April 2005

CONTEXT: Cutaneous melanoma presents significant morbidity and mortality. Nowadays, about 90% of them are diagnosed by clinical examination and most are localized melanomas. Sentinel node biopsy has brought about a new and interesting approach towards localized cutaneous melanoma. The meaning of micrometastases in sentinel nodes diagnosed by the reverse transcriptase-polymerase chain reaction is not well established. OBJECTIVE: To define the real value of micrometastases diagnosed by the reverse transcriptase-polymerase chain reaction in relation to melanoma recurrence. METHODS: Systematic literature review and meta-analysis. The Cochrane Library, Medline, Embase and Lilacs were the databases searched. We used the following key words: sentinel node and melanoma; sentinel node and reverse transcriptase-polymerase chain reaction; melanoma and reverse transcriptase-polymerase chain reaction. Cohort studies enrolling localized cutaneous melanoma patients who underwent sentinel node biopsy were selected. Sentinel node evaluations included hematoxylin and eosin, immunohistochemistry and reverse transcriptase-polymerase chain reaction. RESULTS: Out of the 1,542 studies evaluated, four were eligible. The four studies, when combined, were statistically homogeneous. The sample totaled 450 patients grouped as follows: 163 with a sentinel node negative to hematoxylin eosin and immunohistochemistry and positive to the reverse transcriptase-polymerase chain reaction; 192 with a sentinel node negative to hematoxylin eosin, immunohistochemistry and the reverse transcriptase-polymerase chain reaction and 95 patients with a sentinel node positive to hematoxylin eosin and/or immunohistochemistry. We analyzed the first two groups. The meta-analysis for the random model showed an increased effect from a positive reverse transcriptase-polymerase chain reaction on the recurrence rate. A similar result occurred in the meta-analysis for the fixed effect model. CONCLUSION: Patients with a positive reverse transcriptase-polymerase chain reaction had a greater recurrence rate than those with a negative reverse transcriptase-polymerase chain reaction. This suggests an important role for the reverse transcriptase-polymerase chain reaction in sentinel node examinations. In view of the small sample, a clinical trial could better evaluate this question.
Casual blood pressure and ambulatory blood pressure measurement in children
Authors: Koch Vera Hermina
Published: April 2005

Some epidemiological studies on blood pressure among children and adolescents have revealed that blood pressure levels in childhood are the strongest predictors of adult blood pressure levels. In the adult population, hypertension causes a two to threefold increase in an individual's risk of cardiovascular morbidity. Cardiovascular risk depends on blood pressure itself, coexistent risk factors and whether there is hypertensive end-organ damage. Therefore, accuracy in determining blood pressure is essential and a standardized protocol should be considered for blood pressure measurement, which would make the comparison of results obtained by different studies in different countries possible. This article reviews the main determinants of accuracy for casual and ambulatory blood pressure measurements in children.
Clinical variables of preoperative risk in thoracic surgery
Authors: Saad Ivete Alonso Bredda , De Capitani Eduardo Mello , Toro Ivan Felizardo Contrera , Zambon Lair
Published: April 2005

CONTEXT: Pulmonary complications are the most common forms of postoperative morbidity in thoracic surgery, especially atelectasis and pneumonia. The first step in avoiding these complications during the postoperative period is to detect the patients that may develop them. OBJECTIVE: To identify risk variables leading to early postoperative pulmonary complications in thoracic surgery. DESIGN: Prospective study. SETTING: Hospital das Clínicas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. PATIENTS: 145 patients submitted to elective surgery were classified as low, moderate and high risk for postoperative pulmonary complications using a risk assessment scale. PROCEDURES: The patients were followed up for 72 hours after the operation. Postoperative pulmonary complications were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. MAIN MEASUREMENTS: Univariate analysis was applied in order to study these independent variables: age, nutritional status, body mass index, respiratory disease, smoking habit, spirometry and surgery duration. Multivariate logistic regression analysis was performed in order to evaluate the relationship between independent and dependent variables. RESULTS: The incidence of postoperative complications was 18.6%. Multivariate logistic regression analysis showed that the variables increasing the chances of postoperative pulmonary complications were wheezing (odds ratio, OR = 6.2), body mass index (OR = 1.15), smoking (OR = 1.04) and surgery duration (OR = 1.007). CONCLUSION: Wheezing, body mass index, smoking and surgery duration increase the chances of postoperative pulmonary complications in thoracic surgery
Regulation of cell cycles is of key importance in human papillomavirus (HPV)-associated cervical carcinogenesis
Authors: Brenna Sylvia Michelina Fernandes , Syrjänen Kari Juhani
Published: April 2005

The rapid progress in molecular biology has allowed the identification of the genes involved in different functions of normal cells and has also improved our understanding of the mechanisms of human carcinogenesis. The human papillomavirus (HPV) is a small double-stranded DNA tumor virus and its genes can manipulate cell cycle control to promote viral persistence and replication. The E6 and E7 proteins of high-risk HPV bind to cell cycle regulatory proteins and interfere with both G1/S and G2/M cell cycle checkpoints much more effectively than the low-risk HPV. The difference between the ability of low and high-risk HPV types to induce immortalization and transformation may well lie in their abilities to interact with the various cell cycle components, resulting in the loss of multiple cell cycle checkpoints, which are important in host genome fidelity, thus potentially resulting in accumulation of genetic abnormalities. Cervical cancer is one of the leading malignancies in women worldwide, with substantial morbidity and mortality. According to current concepts, HPV is recognized as the single most important causal agent in the pathogenesis of this cancer. HPV infection clearly precedes the development of malignancy, while being regularly associated with cervical cancer precursor lesions (all grades of squamous intraepithelial lesions). HPV-infected low-grade squamous intraepithelial lesion (SIL) has three possible outcomes: a) it may regress; b) it can persist; or c) it can make a clinical progression to in situ or invasive carcinoma. It has been well established by prospective cohort studies that the spontaneous regression rate increases in parallel with follow-up duration. In contrast, the clinical progression of lesions usually takes place quite rapidly, i.e. during the first two years from diagnosis. The mechanisms responsible for this divergent clinical behavior of HPV-associated squamous intraepithelial lesions are largely unknown, but currently under intense study in different laboratories worldwide.
Beckwith-Wiedemann syndrome and isolated hemihyperplasia
Authors: Gomes Marcus Vinícius de Matos , Ramos Ester Silveira
Published: April 2005

CONTEXT: Beckwith-Wiedemann syndrome is a complex and heterogeneous overgrowth syndrome with genetic and epigenetic alterations, involving genomic imprinting and cancer predisposition. Isolated hemihyperplasia is of unknown cause, and it may represent a partial or incomplete expression of Beckwith-Wiedemann syndrome. OBJECTIVES: A clinical and molecular review and proposal of the use of an experimental protocol to provide a practical approach for the physician. DATA SYNTHESIS: This review demonstrates the genetic and epigenetic mechanisms involved in the Beckwith-Wiedemann syndrome and isolated hemihyperplasia, and the candidate genes. To our knowledge, this is the first Brazilian protocol for research into these disorders. The results have been used at the Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, to elucidate the basis of Beckwith-Wiedemann syndrome and isolated hemihyperplasia, and have been applied at the Hospital Universitário of the Faculdade de Medicina. CONCLUSIONS: Elucidation of the etiological mechanisms and use of a laboratory protocol to detect alterations in these disorders may be useful for guiding the management of such patients and genetic counseling of the families.
Forensic autopsy costs in the city of São Paulo
Authors: Herbella Fernando Augusto Mardiros , Fernandes Pedro Herbella , Delmonte Carlos , Del Grande José Carlos
Published: April 2005

CONTEXT: Modern medical practice involves cost analysis of therapeutic and diagnostic procedures. There are no papers dealing with this theme in relation to forensic autopsies in our country. OBJECTIVE: Analysis of direct costs of forensic autopsies. TYPE OF STUDY: Cost analysis. SETTING: São Paulo Medical Examiner's Central Office. SAMPLE: Year 2001 activity. PROCEDURES: Routine forensic autopsies. MEAN MEASUREMENTS: Analysis of direct costs of personnel and material. RESULTS: Cost of personnel represents 90.38% or US$ 93.46. Material expenses comprised 9.62% or US$ 9.95. Total costs were calculated to be US$ 103.41. CONCLUSIONS: Forensic autopsies have a high cost. Cases to be autopsied should be judiciously selected. Our results are similar to international studies if data are rearranged based on the number of annual necropsies.
p53, estrogen and progesterone receptors in diagnostic curettage for endometrial adenocarcinoma and their correlation with morphological data and disease stage at hysterectomy
Authors: Bonfitto Vera Lúcia Leite , Andrade Liliana Aparecida Lucci de Angelo
Published: April 2005

CONTEXT: Diagnostic staging is an important prognostic factor for endometrial adenocarcinoma. Apart from the histological type and histological grade, some markers seem to be associated with the stage and biological behavior of the disease. Among these are p53, estrogen and progesterone receptors. OBJECTIVE: The objectives of the present study were: to compare histological type and grading of endometrial carcinoma in curettage and hysterectomy samples; to assess expression of p53, estrogen and progesterone receptors in curettage specimens; and to correlate these data with morphology and staging of the disease in hysterectomy specimens. TYPE OF STUDY: Retrospective. SETTING: Department of Pathology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. SAMPLE: Histological diagnosis from 51 consecutive files. PROCEDURES: Immunohistochemical reactions for p53, estrogen and progesterone receptors via the avidin-biotin-peroxidase method in 51 curettage samples endometrial carcinoma were compared with the morphological data and disease stage in hysterectomy. Marker expression was correlated with histological type and grade and the final stage of the disease. RESULTS: According to the histological type: 44 cases (86%) were of endometrioid and 7 (14%) non-endometrioid carcinoma. p53 expression was observed in 16% of endometrioid and 71% of non-endometrioid cases (p < 0.05). Although estrogen expression was more evident in endometrioid (54%) than non-endometrioid cases (29%), this was not statistically significant. Progesterone receptor expression was significantly higher in endometrioid than non-endometrioid cases (70% vs. 14%, p < 0.05). According to the histological grade: Estrogen and progesterone receptors were expressed more frequently in grade I endometrioid carcinoma, while p53 was mainly reported in tumor grades II and III. According to final disease stage: p53 and estrogen expression in curettage specimens was not related to stage; progesterone receptors, however, were expressed significantly less in advanced disease. CONCLUSION: p53 was observed in the majority of non-endometrioid and in high-grade endometrioid carcinoma, but was not related to stage. Estrogen and progesterone receptors were mainly found in grade I endometrioid carcinoma. The markers studied in curettage were no more valuable for predicting the disease stage than classical histological criteria.
Meigs' syndrome with elevated CA 125: case report
Authors: Vieira Sabas Carlos , Pimentel Leonardo Halley Carvalho , Ribeiro José Carlos Castelo Branco , Andrade Neto Argemiro Ferreira de , Santana Jerúsia Oliveira Ibiapina de
Published: April 2005

CONTEXT: Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovarian tumor. However, patients with Meigs' syndrome can also have elevated serum CA 125 levels. The authors report a case of Meigs' syndrome with elevated CA 125 level. OBJECTIVE: This is a case report of Meigs' syndrome with elevated CA 125 level. CASE REPORT: A 65-year-old Brazilian woman had presented progressive dyspnea, weight loss and decline in general condition over the 7 months preceding admission to our service. In another hospital, the patient had been submitted to thoracic drainage due to pleural effusion. With recurrence of the pleural effusion and increase in abdominal volume due to ascites and a pelvic mass, the patient sought our service. Transvaginal ultrasound showed an extensive adnexal solid mass of 16.4 x 10.8 cm located in the pelvis without exact limits, and the serum CA 125 level was elevated. With a preoperative diagnosis of ovarian carcinoma, the patient was submitted to exploratory laparotomy, which revealed a left ovarian tumor. The frozen section diagnosis was thecoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histology of the specimen confirmed the diagnosis of thecoma. The patient was asymptomatic with a normal serum CA 125 level 20 months after the operation.
Prevalence of diabetes mellitus and impaired glucose tolerance in the urban population aged 30-69 years in Ribeirão Preto (São Paulo), Brazil
Authors: Torquato Maria Teresa da Costa Gonçalves , Montenegro Junior Renan Magalhães , Viana Luis Atílio Losi , Souza Rui Augusto Hudari Gonçalves de , Lanna Carla Márcia Moreira , Lucas Júlio César Batista , Bidurin Cláudio , Foss Milton Cesar
Published: April 2005

CONTEXT: Diabetes mellitus prevalence has been increasing worldwide due to factors like lifestyle changes and higher life expectancy. The Brazilian Multicenter Study performed between 1986 and 1988 evaluated the prevalence of diabetes and impaired glucose tolerance. OBJECTIVE: To assess the prevalence of diabetes and impaired glucose tolerance in the urban population aged 30-69 years of the city of Ribeirão Preto, SP, Brazil. TYPE OF STUDY: A two-stage, cross-sectional home survey. SETTING: Ribeirão Preto, São Paulo, Brazil. PARTICIPANTS: A random sample of 1,473 individuals. METHODS: The sample plan was drawn up using a sampling scheme of stage conglomerates according to sex, age and family head income. Subjects were first screened by fasting capillary glycemia (FCG). Those that screened postiive (FCG > 100 mg/dl) and every seventh consecutive person who screened negative (FCG < 100 mg/dl) was submitted to a 75 g oral glucose tolerance test. The diagnosis of diabetes and impaired glucose tolerance were based on World Health Organization criteria. RESULTS: The overall rates of diabetes and impaired glucose tolerance were 12.1 and 7.7%, respectively. Men and women had similar rates of diabetes (12.0 vs. 12.1%) and impaired glucose tolerance (7.9 vs. 7.3%). Differences in the rates for whites (11.6%) and nonwhites (13.3%) for diabetes were not significant, while impaired glucose tolerance was more prevalent among whites. The prevalences of diabetes and impaired glucose tolerance ranged from 3.3% and 2.6% in the 30-39 year age group to 21.7% and 11.3% in the 60-69 year age group, respectively. Obese subjects (BMI > 30 kg/m²) and those with a family history of diabetes (first-degree relatives) presented higher prevalences of diabetes (22.6% and 19.7%, respectively). CONCLUSIONS: The prevalence of diabetes in Ribeirão Preto was found to be comparable to that occurring in developed countries. With respect to the Brazilian Multicenter Study we verified an increased prevalence of diabetes but a similar prevalence of impaired glucose tolerance. These findings may reflect modifications in environmental factors and lifestyle that have been occurring in Brazilian cities like Ribeirão Preto, especially regarding increasing rates of sedentary living and obesity.
Clinical skills assessment: limitations to the introduction of an "OSCE" (Objective Structured Clinical Examination) in a traditional Brazilian medical school
Authors: Troncon Luiz Ernesto de Almeida
Published: April 2005

CONTEXT: Assessment of clinical skills has a central role in medical education and the selection of suitable methods is highly relevant. The OSCE (Objective Structured Clinical Examination) is now established as one of the most valid, reliable and effective tests for the assessment of clinical skills. OBJECTIVE: To describe student and faculty perceptions of an OSCE introduced in a traditional Brazilian medical school. TYPE OF STUDY: Descriptive, semi-quantitative study. SETTING: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. PARTICIPANTS: 258 junior medical students finishing an introductory course on basic clinical skills and six faculty members deeply involved with the OSCE administration. PROCEDURES: Over a period of three consecutive years, student perceptions on the examination were evaluated using a structured questionnaire containing several five-point scales; faculty members' opinions were collected using a structured questionnaire plus a personal interview. MAIN MEASUREMENTS: Student satisfaction or dissatisfaction with aspects of OSCE administration and positive or negative opinions from faculty members. RESULTS: Students were comfortable with cases and tasks, but nearly half (48%) of them criticized organizational aspects of the OSCE. Substantial proportions of students reported difficulties with both time management (70%) and stress control (70%). Improvement of several aspects of exams reduced criticism of organization to a minority (5%) of students, but the proportions of students reporting difficulties with time management (40%) and stress control (75%) during the exam remained virtually unchanged. Faculty members acknowledged the accuracy of the OSCE, but criticized its limitations for assessing the integrated approach to patients and complained that the examination was remarkably time and effort-consuming. The educational impact of the OSCE was felt to be limited, since other faculty members did not respond to the communication of exam results. CONCLUSIONS: In addition to shortage of resources and organizational difficulties, local cultural aspects and the absence of a more favorable educational climate may hinder lasting improvements in assessment methods in traditional medical schools.
Allelic imbalance studies of chromosome 9 suggest major differences in chromosomal instability among nonmelanoma skin carcinomas
Authors: Gomes Gabriela Pereira , Moraes Aparecida Machado , Stoff Hamilton Ometto , Ward Laura Sterian
Published: April 2005

CONTEXT: Loss of heterozygosity in the 9p21-p22 region, has been frequently described in a wide range of human malignancies, including familial melanomas. Also, losses and gains in other regions of chromosome 9 have frequently been observed and may indicate additional mechanisms for basal cell tumorigenesis. OBJECTIVE: To investigate allelic imbalance in the 9p21-p22 region, among basal cell carcinomas. TYPE OF STUDY: Microsatellite analysis. SETTING: Two dermatology services of public universities in São Paulo and the Laboratory of Cancer Molecular Genetics of Universidade Estadual de Campinas (Unicamp). PARTICIPANTS: 13 patients with benign skin lesions consecutively referred to the outpatient dermatology clinics of Unicamp and Universidade Estadual de São Paulo (Unesp) and 58 with malignant skin tumours. MEAN MEASUREMENTS: We examined 13 benign cases including four of solar keratosis, three keratoachanthomas, three melanocytic nevi, two of Bowen's disease and one of neurofibroma, and 58 malignant skin tumors: 14 of squamous cell, 40 basal cell carcinomas and four melanomas. Participating patients had the main tumor and a normal portion of non-adjacent skin surgically removed. DNA was extracted from the tumor and matching normal tissue. We used four sets of primers to amplify polymorphic microsatellite repeats on chromosome 9, two of them targeting the 9p21-p22 region. RESULTS: We identified eight cases (20%) of allelic imbalance among basal cell carcinomas, two cases of loss of heterozygosity and six cases of microsatellite instability in the 9p21-p22 region. Additional markers were also involved in three of these tumors. No events were detected among the benign or the other malignant cases. CONCLUSION: This phenotype dependency suggests that there is a major distinction between the two most important forms of nonmelanoma skin cancers in their tendency to present microsatellite instability in chromosome 9. Since the CDKN2a/p16INK4a, p19ARF and p15INK4b tumor suppressor genes do not appear to be responsible for the observed abnormalities, other genes at 9p21-p22 may be involved in the pathogenesis and progression pathway of basal cell carcinomas.
Lingual thyroid causing dysphonia: case report
Authors: Tincani Alfio José , Martins Antonio Santos , Del Negro André , Araújo Priscila Pereira Costa , Barretto Gilson
Published: April 2005

CONTEXT: Lingual thyroid gland is a rare clinical entity that is caused by the failure of the thyroid gland to descend to a normal cervical location during embryogenesis. The occurrence of an ectopic thyroid gland located at the base of the tongue may cause problems for the patient, with symptoms of dysphagia, dysphonia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood. CASE REPORT: We report on a case of lingual thyroid gland in a 41-year-old female patient. The embryology and diagnosis of ectopic thyroid are discussed and its management is outlined. Features of the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, thyroid scan and computed tomography imaging studies employed in the confirmation of diagnosis and planning of appropriate treatment. The history of the condition is reviewed and a treatment strategy is outlined. Surgical excision of the gland is reserved for cases of gland enlargement that result in compromised airways (dysphagia or dysphonia) or recurrent hemorrhage.
Surgery or general medicine: a study of the reasons underlying the choice of medical specialty
Authors: Bellodi Patrícia Lacerda
Published: April 2005

CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP). METHODS: A randomized sample of resident doctors in general medicine (30) and surgery (30) was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30%) choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%). Most residents in both fields (73% general medicine, 70% surgery) said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%), intellectual activities (30%) and knowledge of the field (27%). For surgeons the main reasons were practical intervention (43%), manual activities (43%) and the results obtained (40%). Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries with different social and educational characteristics. This congruence indicates that the choice involves very similar desires and needs in different settings and has little dependence on the students' educational context.
Multiple lymphomatous polyposis of the gastrointestinal tract
Authors: Franco Maria Isete Fares , Waisberg Jaques , Lopes Leonardo Seligra
Published: April 2005

CONTEXT: Gastrointestinal multiple lymphomatous polyposis is a rare type of malignant lymphoma that has aggressive biological behavior, early systemic dissemination and poor prognosis. It is considered to be a manifestation of non-Hodgkin lymphoma and represents the gastrointestinal counterpart of mantle cell nodal lymphoma. OBJECTIVE: A case of gastrointestinal multiple lymphomatous polyposis is presented and the anatomopathological, clinical, diagnostic and treatment aspects of this unusual neoplasia are discussed. CASE REPORT: The patient was a 59-year-old white male with a complaint of asthenia, night sweating, alteration in intestinal habit and weight loss over the preceding two months. The physical examination showed pallid mucosa and a palpable mass in the epigastrium and mesogastrium. Endoscopy of the upper digestive tract showed the presence of gastric and duodenal polyps. An opaque enema showed multiple polypoid lesions, especially in the cecum. A rectal biopsy revealed infiltration of the mucosa and submucosa by diffuse lymphoma consisting of small cleaved cells. Immunohistochemical study showed lymphocytes that expressed the antibody CD20 (L-26) and light-chain kappa (k) immunoglobulin, but not light-chain lambda (l) immunoglobulin. The patient presented a condition of acute intestinal obstruction with the presence of a mesenteric mass formed by agglutinated lymph nodes that surrounded the proximal ileum, thereby obstructing its lumen. He was submitted to a segmental enterectomy and gastrotomy with excisional biopsies of the gastric polypoid lesions. After two cycles of chemotherapy there was a worsening of the general state, with an increase in the dimensions of the abdominal masses and sepsis, accompanied by progressive respiratory insufficiency, leading to death.
Clinical and demographic profile of users of a mental health system for medical residents and other health professionals undergoing training at the Universidade Federal de São Paulo
Authors: Fagnani Neto Rafael , Obara Cristina Sueko , Macedo Paula Costa Mosca , Cítero Vanessa Albuquerque , Nogueira-Martins Luiz Antonio
Published: April 2005

CONTEXT: A postgraduate and resident trainee mental health assistance center was created in September 1996 within our university. OBJECTIVE: To describe the clinical and demographic profile of its users. TYPE OF STUDY: Retrospective. SETTING: Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM). METHODS: The study was carried between September 1996 and November 2002, when 233 semi-structured registration forms were filled out either by the psychologist or the psychiatrist during their first contact with the trainees, who were medical and nursing residents, and postgraduate students at specialization, master or doctoral levels. The registration forms included demographic, occupational and clinical data. RESULTS: The trainees were predominantly young (mean of 27 years old), single (82.0% of cases), women (79.4%), seeking help especially during the first year of training (63.1%). In 70.8% of the cases, they came to the service spontaneously. Such individuals showed greater adherence to the treatment than those who were referred by supervisors (p < 0.05). In 30% of the cases, the trainee sought psychological guidance or support at the service due to specific situational conflicts. Depression and anxiety disorders were the most frequent diagnoses; 22.3% of the trainees followed up mentioned a tendency towards suicidal thoughts. In comparison with other trainees, there was a higher prevalence of males among the medical residents (p < 0.01), with more cases of sleep disorders (p < 0.05), a smaller number of individuals refraining from the use of alcohol (p < 0.05) and a higher number of trainees requiring leave of absence (p < 0.001). DISCUSSION: The first year of training in health sciences is the most stressful, especially for women. Depression and anxiety symptoms are common, reflecting transitory self-limited deadaptation. However, the severity of the cases can also be evaluated in view of the large number of trainees who mentioned suicidal tendencies. CONCLUSIONS: This study emphasizes the need and importance of providing formal, structured and confidential mental health services for medical residents and postgraduate students from other health professions, in the training programs of academic institutions.
Multiple drug resistance protein (MDR-1), multidrug resistance-related protein (MRP) and lung resistance protein (LRP) gene expression in childhood acute lymphoblastic leukemia
Authors: Valera Elvis Terci , Scrideli Carlos Alberto , Queiroz Rosane Gomes de Paula , Mori Bianca Maria Ortelli , Tone Luiz Gonzaga
Published: April 2005

CONTEXT: Despite the advances in the cure rate for acute lymphoblastic leukemia, approximately 25% of affected children suffer relapses. Expression of genes for the multiple drug resistance protein (MDR-1), multidrug resistance-related protein (MRP), and lung resistance protein (LRP) may confer the phenotype of resistance to the treatment of neoplasias. OBJECTIVE: To analyze the expression of the MDR-1, MRP and LRP genes in children with a diagnosis of acute lymphoblastic leukemia via the semiquantitative reverse transcription polymerase chain reaction (RT-PCR), and to determine the correlation between expression and event-free survival and clinical and laboratory variables. DESIGN: A retrospective clinical study. SETTING: Laboratory of Pediatric Oncology, Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil. METHODS: Bone marrow aspirates from 30 children with a diagnosis of acute lymphoblastic leukemia were assessed for the expression of messenger RNA for the MDR-1, MRP and LRP genes by semi-quantitative RT-PCR. RESULTS: In the three groups studied, only the increased expression of LRP was related to worsened event-free survival (p = 0.005). The presence of the common acute lymphoblastic leukemia antigen (CALLA) was correlated with increased LRP expression (p = 0.009) and increased risk of relapse or death (p = 0.05). The relative risk of relapse or death was six times higher among children with high LRP expression upon diagnosis (p = 0.05), as confirmed by multivariate analysis of the three genes studied (p = 0.035). DISCUSSION: Cell resistance to drugs is a determinant of the response to chemotherapy and its detection via RT-PCR may be of clinical importance. CONCLUSIONS: Evaluation of the expression of genes for resistance to antineoplastic drugs in childhood acute lymphoblastic leukemia upon diagnosis, and particularly the expression of the LRP gene, may be of clinical relevance, and should be the object of prospective studies.
Changes in eating habits following total and frontolateral laryngectomy
Authors: Pillon Jackeline , Gonçalves Maria Inês Rebelo , De Biase Noemi Grigoletto
Published: April 2005

CONTEXT: Swallowing is a continuous dynamic process, characterized by complex stages, that involves structures of the oral cavity, pharynx, larynx and esophagus. It can be divided into three phases: oral, pharyngeal and esophageal. Dysphagia is characterized by difficulty with, or the inability to swallow food of normal consistencies. OBJECTIVE: To investigate the presence of swallowing difficulties and modifications made to the consistency of the food consumed in cases of total and partial laryngectomy, with or without subsequent radiotherapy, among patients who had not been diagnosed as having dysphagia. TYPE OF STUDY: Descriptive study. SETTING: Voice Clinic of São Paulo Hospital, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil. METHOD: 36 laryngectomy patients: 25 total and 11 frontolateral cases, were studied. A survey consisting of a 23-item questionnaire was applied by a single professional. RESULTS: Among those interviewed, 44% reported having modified the consistency of the food consumed (56% of the total and 20% of the partial frontolateral laryngectomy cases). It was not possible to investigate the influence of radiotherapy on the groups in this study, because the partial frontolateral laryngectomy cases were not exposed to radiotherapy. There was a higher incidence of complaints of swallowing difficulties in total laryngectomy cases (p < 0.027) than in partial frontolateral cases. However, there was no relationship between the surgery and weight loss. We also noted the patients' other problems regarding the eating process, as well as the compensation that they made for such problems. DISCUSSION: Research has shown an association between laryngectomy and swallowing difficulties, although there have been no reports of associated changes in eating habits among laryngectomized patients. CONCLUSIONS: This study showed that difficulty in swallowing is not rare in total and frontolateral laryngectomy cases. Such patients, even those who did not complain of dysphagia, also had minor difficulties while eating, and had to make some adaptations to their meals.
Inflammatory pseudotumor of the spleen concomitant with renal cell carcinoma: case report
Authors: Ioshii Sérgio Ossamu , Sakamoto Danielle Giacometti , Machuca Tiago Noguchi , Yatani Ryuichi
Published: April 2005

CONTEXT: Inflammatory pseudotumor is a rare benign lesion that can occur at a wide variety of primary sites. It is usually worrisome for the patient and the medical staff, since it cannot be clinically or radiologically distinguished from malignant entities. CASE REPORT: We report on a case of splenic inflammatory pseudotumor presenting with concomitant renal cell carcinoma. Despite the alarming macroscopic appearance of pseudotumors, their microscopic features usually confirm the inflammatory nature of such lesions. Evidence regarding the etiology of pseudotumors is still lacking, but hypotheses have been created.
Head and neck hemangiopericytoma in a child: case report
Authors: Carvalho Jomar Rezende , Haddad Leonardo , Leonhardt Fernando Danelon , Marques Filho Marcílio Ferreira , Santos Rodrigo de Oliveira , Cervantes Onivaldo , Abrahão Márcio
Published: April 2005

CONTEXT: Hemangiopericytoma is a relatively rare tumor, first described in 1942, with approximately 300 cases described in the literature to date. In most cases, it affects the trunk and lower extremities. The head and neck incidence is less than 20%, mostly in adults. We describe a case of malignant head and neck hemangiopericytoma in a child. TYPE OF STUDY: Case report. CASE REPORT: A twelve-year-old male patient noted the presence of a firm painless right-side retroauricular lymph node of 1 cm in diameter, which at first remained unchanged for six months, but subsequently enlarged progressively. He denied having had previous trauma at that site. In November 2000, he presented nasal obstruction and voluminous epistaxis that required hospitalization and blood transfusion. During dental treatment one month later, a cranial x-ray revealed bone alterations. A subsequent computed tomography scan showed an extensive lesion of soft tissue density that had invaded the maxillary fossa, eroding the skull base and middle and nasal fossa. The child was then referred to our service, where biopsy was performed, giving a diagnosis of hemangiopericytoma. Shortly afterwards, magnetic resonance imaging revealed that this lesion had undergone significant growth, while maintaining the same invasion pattern. The patient was submitted to conservative surgery in April 2001, with only partial resection of the tumor because of its extent. Histopathological examination of the specimen confirmed the presence of malignant hemangiopericytoma. Following the surgery, the patient presented fast regrowth of the lesion, with partial response to chemotherapy and radiotherapy.
Acquired hemoglobin H disease in a patient with aplastic anemia evolving into acute myeloid leukemia
Authors: Figueiredo Maria Stella , Vicari Perla , Kimura Eliza Yuriko Sugano , Antunes Sandra Vallin , Yamamoto Mihoko
Published: April 2005

CONTEXT: The prognosis of severe aplastic anemia has improved since the introduction of bone marrow transplantation and treatment with antithymocyte globulin. In contrast to the success of these protocols, studies with long term follow-up have shown the occurrence of clonal diseases such as paroxysmal nocturnal hemoglobinuria, myelodysplastic syndrome and acute leukemia in aplastic anemia. CASE REPORT: We report the first case of a Brazilian patient with aplastic anemia who developed myelodysplastic syndrome and acute myeloid leukemia showing acquired hemoglobin H and increased fetal hemoglobin.
Pulsed field gel electrophoresis reveals chromosome length and number differences in Brazilian strains of Metarhizium Anisopliae
Authors: Kava-Cordeiro Vanessa , Queiroz Marisa Vieira de , Pizzirani-Kleiner Aline Aparecida , Azevedo João Lúcio
Published: April 2005

Electrophoretic karyotypes of eight wild-type strains of Metarhizium anisopliae var. anisopliae were obtained by pulsed-field gel electrophoresis. These strains were isolated from insects of six different Brazilian states. The chromosomal DNA molecules of three strains were separated into seven bands and of five strains into eight bands. Chromosome length polymorphisms were also observed. The size of the chromosomal DNA of all strains varied between 7.7 and 0.9 Mb using the Aspergillus nidulans chromosomes as size standards. The total genome size of these strains was estimated in at least 29.7 Mb. Some correlations between differences in karyotype and occurrence of parasexual cycle likewise the host specificity were discussed.
Morphology of female reproductive tract of the predator Podisus nigrispinus (Dallas) (Heteroptera: Pentatomidae) fed on different diets
Authors: Lemos Walkymário de Paulo , Ramalho Francisco de Souza , Serrão José Eduardo , Zanuncio José Cola
Published: April 2005

The morphology of the reproductive tract of Podisus nigrispinus (Dallas) females fed with Alabama argillacea (Hübner) larvae, artificial diet, Tenebrio molitor L. larvae or Musca domestica L. larvae were studied. The reproductive tract of females of this species presented yellow coloration and independent of the diet, each ovary had seven ovarioles joined through terminal filaments and forming a bunch shape structure. The histological data revealed that the ovary of P. nigrispinus was of meroistic telotrophic type, with each individual ovariole divided in a terminal filament, a tropharium (trophic chamber), a vitellarium, and a pedicel. The prey type affected the development and morphometry of these structures. Females of P. nigrispinus fed with 3rd or 5th instar larvae of cotton leafworm (A. argillacea) presented developed ovaries with ovarioles showing a great number of oocytes in advanced stages of development. Females fed with artificial diet presented atrophic ovaries and ovarioles practically without oocytes. Females fed with T. molitor or M. domestica showed ovaries in intermediary stage of development. The central ovariole was longer in females fed with 5th instar larvae of cotton leafworm and shorter in those fed with artificial diet. Most developed oocytes were observed in ovaries of females fed with 5th or 3rd instar larvae of cotton leafworm, and the majority of atrophic oocytes were found in females fed with artificial diet.
Role of intermediary cells in Peltodon radicans (Lamiaceae) in the transfer of calcium and formation of calcium oxalate crystals
Authors: Paiva Elder Antônio Sousa , Machado Silvia Rodrigues
Published: April 2005

With the objective of studying the connection between calcium oxalate crystals formation and the phloem, fragments of leaves of Peltodon radicans Pohl (Lamiaceae) were fixed and processed, for light and electron-transmission microscopes. It was observed that the crystals occurred in the cells of the bundle sheath, juxtaposed in relation to the phloem. Intermediary cells established a connection between the sieve element and crystal-bearing sheath cells. Calcium was present abundantly in the cytoplasm of sheath cells as calcium oxalate crystals. The presence of calcium was also detected in the intermediary cells, but in the sieve elements it was not detected. There was, therefore, an increasing concentration gradient of calcium in the sieve elements from sheath cells. Thus, we hypothesized that the formation of calcium oxalate crystals regulates calcium levels in the sieve elements.
Moralidade e responsabilidade em tempos sombrios
Authors: Benedikt Adriana
Published: April 2005

Este ensaio pretende discutir a questão da moralidade em tempos de crise a partir das contribuições do psicanalista inglês Donald Winnicott sobre o surgimento da preocupação-com-o-outro e da reflexão do sociólogo polonês Zygmunt Baumann sobre moralidade e responsabilidade. Concluímos com a sugestão de que nosso desafio talvez esteja exatamente no desenvolvimento de nossa capacidade de imaginação tendo como objetivo a superação da equação proposta entre proximidade-moralidade/distância-imoralidade. Talvez apenas o poder da imaginação, o poder com o qual uma pessoa consegue se imaginar no lugar da outra, possa nos dar alguma esperança, e possibilitar que, mesmo à distância, possamos nos sentir moralmente responsáveis uns pelos outros.
Construindo a possibilidade da participação dos usuários: conselhos e conferências no Sistema Único de Saúde
Authors: Cortes Soraya Maria Vargas
Published: April 2005

O artigo discute o trabalho de autores que afirmam existir dificuldades em criar canais participatórios nos países em desenvolvimento em geral, e na América Latina em particular, devido à fraqueza de suas instituições políticas e sociedades civis. Na área da saúde, as iniciativas para promover a participação teriam resultado em fracasso. Argumenta-se, em contrapartida, que a experiência brasileira, com os conselhos e as conferências de saúde, não confirma integralmente tais afirmações. O artigo também examina as origens históricas, a criação e o papel político-institucional desses fóruns, no contexto da reforma do sistema brasileiro de saúde. Ao final, o artigo analisa os determinantes do sucesso de um processo participatório em conselhos e conferências de saúde.
Análise comparativa dos efeitos da base socioeconômica, dos tipos de crime e das condições de prisão na reincidência criminal
Authors: Fandiño Mariño Juan Mario
Published: April 2005

O objetivo central do trabalho é identificar e mensurar o poder explicativo relativo das seguintes três dimensões causais hipotéticas da reincidência criminal: a) variáveis biográficas ou socioeconômicas, a saber: estado civil, filhos, naturalidade, idade, religião, raça, instrução formal e nível de qualificação da ocupação; b) tipo de delito, segundo os seguintes oito tipos simplificados: homicídios, lesões corporais, roubos, furtos, estelionatos, posse e uso de entorpecentes e estupros); e c) condições de prisão, incluindo a disponibilidade e qualificação dos funcionários - tanto de segurança quanto administrativos -, trabalho prisional dos apenados, treinamento profissionalizante e instrução em geral, espaços disponíveis e superlotação, e programas de assistência social ao apenado. O trabalho resume e avalia a literatura internacional relativa à reincidência criminal, tanto em termos metodológicos quanto teóricos, e apresenta um panorama histórico recente da criminalidade no estado do Rio Grande do Sul, como pano de fundo da análise da reincidência propriamente dita. Utilizando dados longitudinais oficiais das prisões para os anos de 1989 a 1997, e o cadastro geral oficial de apenados do estado, uma série de regressões é calculada pelo método step-wise, relacionando as três dimensões em questão com a variável reincidência, dicotomizada. A dimensão biográfica explica 32% da reincidência, o tipo de crime explica outros 9%, e as condições de prisão explicam ainda 16%, sugerindo uma ampla influência da política prisional na redução da reincidência.
Uma experiência de integração das polícias civil e militar: os Distritos-Modelo em Fortaleza
Authors: Brasil Glaucíria Mota , Abreu Domingos
Published: April 2005

O presente artigo tem como objetivo discutir e analisar a experiência de integração vivenciada pelos policiais civis e militares a partir das ações policiais desenvolvidas nos Distritos-Modelo, criados no Ceará em 1998. Estes são vistos como modelos de integração de uma política de segurança pública que unificou o seu comando no Estado e tem buscado a integração das ações policiais em toda a estrutura de poder dos aparelhos policiais, apesar das diferenças de atribuições e interesses, das disputas e rusgas existentes entre as duas policias.
Sociologia Brasileira: tendências institucionais e epistemológico-teóricas contemporâneas
Authors: Liedke Filho Enno Dagoberto
Published: April 2005

O artigo revisa, em um primeiro momento, temas da Sociologia do Conhecimento e da Sociologia da Ciência, relevantes para o estudo da Sociologia da Sociologia. Em um segundo momento, propõe-se analisar sete temas referentes ao desenvolvimento da sociologia contemporânea no Brasil.
Diferenças de gênero em relação a bens: a propriedade fundiária na América Latina
Authors: Deere Carmem Diana , Léon Magdalena
Published: April 2005

A diferença de gênero em relação à propriedade fundiária, na América Latina, é significativa. São poucos os países nos quais as mulheres constituem sequer um quarto dos proprietários. A desigualdade de gênero na posse de terras é relacionada à preferência masculina no momento da herança, ao privilégio masculino no casamento, ao viés masculino em programas comunitários e estatais de distribuição de terras, bem como ao viés de gênero no mercado fundiário, sendo que as mulheres têm menor probabilidade do que os homens de serem compradoras bem sucedidas. Mas também existem diferenças importantes por gênero na forma pela qual são adquiridas terras. A herança é o principal meio pelo qual a maioria das mulheres se torna proprietária, enquanto que os homens têm muito maior probabilidade do que as mulheres de adquirirem terras através da sua distribuição por comunidades ou pelo Estado, e por meio do mercado. São destacados os fatores que contribuem para uma tendência no sentido de maior igualdade de gênero na herança de terras e em programas públicos recentes.