O impacto das altas taxas de cesarea sobre a fecundidade de uma população : um estudo de coorte retrospectivo em Campinas, Brasil

Orientadores: Jose Guilherme Cecatti, Anibal FaundesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasDoutorad

Carcinoma de glândulas sebáceas palpebral - diferentes momentos de diagnósticos, diferentes resultados cirúrgicos: relatos de casos

Sebaceous carcinoma of the eyelid is a very rare slow-growing tumor and is considered an aggressive eyelid neoplasm. It can reach mortality rate of about 6%. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions, both clinically and histologically. We present three cases of sebaceous carcinoma, with different surgical outcomes, showing the importance of early diagnosis.Carcinoma sebáceo é um tumor raro de crescimento lento considerado uma das mais agressivas neoplasias palpebrais. Pode alcançar taxa de mortalidade de aproximadamente 6%. O diagnóstico tardio é comum devido a sua habilidade de se confundir com outras lesões perioculares tanto clinicamente quanto histologicamente. Relatamos três casos de carcinoma sebáceo da pálpebra com diferentes resultados cirúrgicos, enfatizando a importância do diagnóstico precoce.Universidade Federal de São Paulo (UNIFESP) Department of OphthalmologyUniversidade Federal de São Paulo (UNIFESP) Department of MorphologyUNIFESP, Department of OphthalmologyUNIFESP, Department of MorphologySciEL

Clinical Aspects of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Severe Ocular Complications in Brazil

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory vesiculobullous reactions that affect the skin and mucous membranes, and which are most often triggered by particular medications and infections. In Brazil, the drugs most frequently associated with TEN and SJS include cold medicine such as dipyrone and NSAIDs, followed by carbamazepine, phenobarbital, penicillin, and allopurinol. Genetic variations have been found to increase the risk of SJS/TEN in response to triggering factors such as medications. The most closely associated genes found in Brazilian cold-medicine-related SJS/TEN patients with severe ocular complications are HLA-A*66:01 in those of mixed African and European ancestry and HLA-B*44:03 and HLA-C*12:03 in those of solely European ancestry. Our classification system for grading ocular surface complication severity in SJS/TEN patients revealed the most severe complications to be limbal stem cell deficiency and dry eye. Changes to the conjunctival flora have also been observed in SJS/TEN patients. Our group identified bacterial colonization in 95% of the eyes (55.5% of which were gram-positive cocci, 25.5% of which were gram-negative bacilli, and 19% of which were gram-positive bacilli). Several new treatment options in the acute and chronic ocular management of the SJS/TEN patients have been described. This article highlights some Brazilian institutions' contributions to ocular surface care in both the acute phase (including the use of amniotic membrane transplantation) and the chronic phase (such as eyelid margin and fornix reconstruction, minor salivary gland transplantation, amniotic membrane and limbal transplantation, scleral contact lenses, anti-angiogenic eyedrops for corneal neovascularization, ex-vivo cultivated limbal epithelium transplantation, conjunctival-limbal autografting, oral mucosa transplantation, and keratoprosthesis)

Fatores associados a prova de trabalho de parto e ao parto vaginal em gestantes com uma cesaria anterior

Orientador: Jose Guilherme CecattiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: o objetivo desse estudo foi a identificação dos fatores médicos e não médicos associados à realização da prova de trabalho de parto e ao parto vaginal em primíparas com uma cesárea anterior e correlacioná-Ios com as atitudes e práticas dos médicos obstetras do município. O estudo foi dividido em duas partes: a primeira correspondeu à realização de um estudo de caso controle aninhado, com uma análise secundária de dados de um estudo de coorte retrospectivo previamente desenvolvido numa população de mulheres que deu à luz ao primeiro filho em Campinas, no ano de 1985. A segunda parte foi um inquérito entre os médicos obstetras de Campinas sobre suas atitudes e práticas relativas à realização da prova de trabalho de parto em gestantes com uma cesárea anterior. Os fatores que estiveram associados à realização da prova de trabalho de parto e ao parto vaginal em gestantes secundigestas com uma c~sárea anterior foram a renda familiar inferior a 5 salários mínimos, o seguro saúde pelo INPS/SUS, a baixa idade materna e a primeira cesárea por indicação de pélvico, gemelar ou transverso. Das mulheres que evoluíram pa~a cesárea no segundo parto, apenas 11 % foram submetidas a uma prova de trabalho de parto. No inquérito entre os obstetras da cidade, aproximadamente 80% responderam que são favoráveis e praticantes dessa prova e em quase a metade dos casos a via de parto final foi vagJnal. Conclui-se que os principais determinantes da realização da prova de trabalho de parto e do parto vaginal em secundigestas com uma cesárea anterior são os fatores sócio-econômicos. Na opinião dos obstetras respondentes essa seria uma alternativa segura para a condução dessas mulheres e o sucesso para parto vaginal ocorre em cerca da metade dos casos, entretanto difere diametralmente da prática observadaAbstract: The purpose of this study was to identify medical and non-medical factors associated with the trial of labourand with vaginal delivery among primipara women with one previous Cesarean section and to compare them with the attitudes and practices reported by obstetricians from the city. The study was divided into two parts: the first corresponded to a nested case control study, on wich a secondary data analysis, of an original retrospective cohort study was carried out on a population of women who delivered their first child during the year of 1985 in the city of Campinas. The second part was a mail survey carried out on ali obstetricians' of . the city with regards their attitudes and practices concerning the trial of labour in pregnant women with one previous Cesarean section. The factors identified as statistically associated to the trial of labour and to a vaginal delivery in these conditions were: monthly family income lower than 5 minimum wages, medical health care through the Brazilian NHS, low maternal age and first Cesarean section indicated by either breech presentation, twins or transverse situation of the fetus. Among those women who also had a Cesarean section in the second delivery, only 11% had undergone a trial of labour. Bas(i)d on the survey, around 80% of obstetricians stated they not only agree with but also practice the trial of labour reporting, for their last case similar to this, vaginal delivery in 50% of the cases. It can be concluded that the main determinants for performing a trial of labour and a vaginal gelivery among women with one previous Cesarean section were social and economic factors. According to the obstetricians questioned the trial of labour would be a safe alternative of conduct for these women, and the success to a vaginal delivery occurs in around 50% of the cases, which is nonetheless completely different from what is observed in practiceMestradoTocoginecologiaMestre em Medicin