Breast cancer with choriocarcinomatous features

This report describes the case of a 45 year-old patient with breast carcinoma characterized by choriocarcinomatous features, presence of bizarre anaplastic cells with areas of necrosis and multinucleated giant cells. The immuno-histochemical analysis showed positivity for chromogranin and β-HCG. The tumor size was 5.7 cm at the largest axis and it was refractory to initial neo-adjuvant treatment. Mastectomy was performed and after microscopic and immuno-histochemical examination it was diagnosed as carcinoma with choriocarcinomatous features. These lesions are rare and liable to synthesize hormonal substances not specific to breast tissue. Its diagnosis is highly significant to the therapeutic and prognostic approach insofar as these lesions are potentially aggressive.O presente relato descreve um caso de carcinoma mamário em paciente de 45 anos, com diferenciação coriocarcinomatosa, caracterizado por presença de células bizarras, anaplásicas, com áreas de necrose e células gigantes multinucleadas, com imunopositividade para a subunidade β da gonadotrofina coriônica humana (β-HCG) e cromogranina, medindo 5,7 cm no maior eixo, refratário ao tratamento neoadjuvante inicial. Realizada mastectomia, cujo diagnóstico após análises microscópica e imuno-histoquímica concluiu tratar-se de carcinoma com características coriocarcinomatosas. Tais lesões são raras, capazes de sintetizar substâncias hormonais não próprias ao tecido mamário, sendo o diagnóstico de grande importância para a abordagem terapêutica e prognóstica, pois constituem um grupo de lesões potencialmente agressivas.Faculdade de Medicina do ABC Serviço de Patologia da MamaFMABCUniversidade Federal de São Paulo (UNIFESP)UNIFESPFMABC Laboratório de Análises ClínicasUNIFESP, EPM, São Paulo, BrazilSciEL

Analysis of quality indexes of the provided health services in public and private services of Angola

Introduction: Quality indices are being increasingly used by leaders, managers and health professionals as operational tools to improve processes and reduce costs. Noting that there is a greater tendency of private hospitals operating in the regulatory model for market mechanisms, it is expected that the quality indicators that serve as a reference for monitoring the health management are more critical in public hospitals. Objective: Evaluate the quality of health services provided in public and private service in Angola. Methods: We analyzed 142 patients of a public and a private institutions in Angola in a structured interview on health indicators. The indices were collected according to the process structure components and results. Results: There are 51,453 calls in the public institution, remaining hospitalized a day, an average of 184 patients,  with an annual rate of bed occupancy of 90.84%. 50% of respondents praised the services and 22% complained about the quality of services. He was appointed as the main grounds for complaint the slow service (17%). The private institution received 2,222 patients, with an average of 570 patients. The mean hospital stay was 4.5 days. The average monthly rate of bed occupancy was 59.9%. In assessing the degree of satisfaction of care, regular or bad satisfaction obtained a rate of 60% in the private institution. Conclusion: There was no favorable results for quality in health management both in public service and in private.Introduction: Quality indices are being increasingly used by leaders, managers and health professionals as operational tools to improve processes and reduce costs. Noting that there is a greater tendency of private hospitals operating in the regulatory model for market mechanisms, it is expected that the quality indicators that serve as a reference for monitoring the health management are more critical in public hospitals. Objective: Evaluate the quality of health services provided in public and private service in Angola. Methods: We analyzed 142 patients of a public and a private institutions in Angola in a structured interview on health indicators. The indices were collected according to the process structure components and results. Results: There are 51,453 calls in the public institution, remaining hospitalized a day, an average of 184 patients,  with an annual rate of bed occupancy of 90.84%. 50% of respondents praised the services and 22% complained about the quality of services. He was appointed as the main grounds for complaint the slow service (17%). The private institution received 2,222 patients, with an average of 570 patients. The mean hospital stay was 4.5 days. The average monthly rate of bed occupancy was 59.9%. In assessing the degree of satisfaction of care, regular or bad satisfaction obtained a rate of 60% in the private institution. Conclusion: There was no favorable results for quality in health management both in public service and in private

Adenomioepitelioma com transformações malignas diagnosticado por imuno-histoquímica: relato de caso

Adenomyoepitheliomas (AMEs) are rare breast lesions, which are characterized by the proliferation of epithelial and myoepithelial cells. They are circumscribed lesions, which can be clinically and mammographically detected. However, when they are indistinctly limited, differential diagnosis with malignant lesions becomes difficult. In this paper, we report a case of adenomyoepithelioma with malignant transformation of the myoepithelial component, a rare histological type that arises from the malignant transformation of epithelial, myoepithelial, or both elements. Its course and prognosis are uncertain. Mastectomy with sentinel lymph node biopsy followed by radiotherapy are the most effective treatment approaches.Adenomioepiteliomas (AMEs) são lesões raras na mama, caracterizadas pela proliferação de elementos epiteliais e mioepiteliais. Clínica e mamograficamente apresentam-se como lesões bem delimitadas, que, quando assumem aspecto mal delimitado, tornam difícil o diagnóstico diferencial com lesões malignas. Relatamos um caso de AME com transformação maligna do componente mioepitelial, tipo histológico ainda mais raro, que surge da transformação maligna de elementos epiteliais, mioepiteliais ou ambos. Seu curso e seu prognóstico são incertos, contudo, mastectomia com pesquisa de linfonodo sentinela seguidos de radioterapia constituem a forma mais efetiva de tratamento.Faculdade de Medicina do ABC Serviço de Patologia da MamaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ciências Exatas e da TerraUNIFESP Departamento de Ciências BiológicasFMABCHospital HeliópolisUNIFESP, Depto. de Ciências Exatas e da TerraUNIFESP, Depto. de Ciências BiológicasSciEL

Standardization of a method to study angiogenesis in a mouse model

In the adult organism, angiogenesis is restricted to a few physiological conditions. On the other hand, uncontrolled angiogenesis have often been associated to angiogenesis-dependent pathologies. A variety of animal models have been described to provide more quantitative analysis of in vivo angiogenesis and to characterize pro- and antiangiogenic molecules. However, it is still necessary to establish a quantitative, reproducible and specific method for studies of angiogenesis factors and inhibitors. This work aimed to standardize a method for the study of angiogenesis and to investigate the effects of thalidomide on angiogenesis. Sponges of 0.5 x 0.5 x 0.5 cm were implanted in the back of mice groups, control and experimental (thalidomide 200 mg/K/day by gavage). After seven days, the sponges were removed. The dosage of hemoglobin in sponge and in circulation was performed and the ratio between the values was tested using nonparametric Mann-Whitney test. Results have shown that sponge-induced angiogenesis quantitated by ratio between hemoglobin content in serum and in sponge is a helpful model for in vivo studies on angiogenesis. Moreover, it was observed that sponge-induced angiogenesis can be suppressed by thalidomide, corroborating to the validity of the standardized method.No adulto, a angiogênese é restrita a poucas condições fisiológicas. Ao contrário, a angiogênese descontrolada frequentemente está associada a patologias dependentes de angiogênese. Vários modelos animais foram descritos para ajudar na análise quantitativa da angiogênese in vivo e caracterizar moléculas pró e antiangiogênicas. Porém, ainda é necessário estabelecer um método quantitativo, reproduzível e específico para estudar os fatores pró e antiangiogênicos. Os objetivos deste trabalho foram padronizar um método para estudar angiogênese e investigar os efeitos da talidomida na angiogênese. Esponjas de 0,5 x 0,5 x 0,5 cm foram implantadas no dorso de camundongos controles e tratados (talidomida 200 mg/K/dia, por gavagem). Após sete dias, as esponjas foram retiradas. Avaliou-se a quantidade de hemoglobina na esponja e na circulação. A razão obtida entre esses valores foi testada por meio do teste não paramétrico Mann-Whitney. Os resultados mostraram que a angiogênese induzida pela esponja e quantificada por meio da razão hemoglobina esponja/circulação é um modelo útil para estudos in vivo de angiogênese. Além disso, observou-se que a angiogênese induzida pela esponja diminui na presença de talidomida, corroborando para a validação do método padronizado.Faculdade de Medicina do ABC Departamento de Morfologia e Fisiologia Disciplina de FarmacologiaUniversidade Federal de São Paulo (UNIFESP) Quimicas e Farmaceuticas Instituto de Ciencias AmbientaisUNIFESP, Quimicas e Farmaceuticas Instituto de Ciencias AmbientaisSciEL

Evaluation of the normothermic ischemic liver injury: the role of main biliary duct occlusion and N-acetylcysteine

BACKGROUND: The aim of this study was to investigate the effect of N-Acetylcysteine (NAC) on the hepatic ischemia injury. METHODS: Thirty eight male EPM-1 Wistar rats were divided in four groups: G1 and G2 with ischemia time of 30 min.; groups 3 and 4 were submitted to 30 min of ischemia and bile duct was not clamped. Animals from groups 2 and 4 received NAC, 150mg.Kg-1 bw, by IV injection, 15 min. before procedure. Blood samples were collected before and after ischemia and liver function was evaluated by enzymatic measurement. Hepatic samples were processed to GSH/GSSG, light and electronic microscopy evaluation. Non-parametric tests were applied to the statistical analysis (p < 0.05). RESULTS: Enzymatic increase were higher when NAC was absent. There was no protection by NAC when bile duct was absent nor when bile duct was not clamped. Under light microscopy there was significant difference in the groups S/NAC X C/NAC, showing that group C/NAC maintained better parenchyma architecture during ischemia time, independent on bile duct clamp. Under electronic microscopy, the groups C/NAC and those without bile duct clamping showed preserved cellular arquitecture. NAC did not alter the relationship between reduced glutathione / oxidated gluthatione (GSH/GSSG). CONCLUSION: NAC is able to protect hepatic parenquime during normothermic ischemia and we purpose that such mechanism is related to a direct reaction of NAC with nitric oxide (NO).OBJETIVO: Estudar o efeito da N-acetilcisteína (NAC) na isquemia hepática. MÉTODO: Trinta e oito ratos machos EPM-1 Wistar foram distribuídos em quatro grupos. Nos Grupos 1 e 2 foi realizado 30 min de clampeamento do hilo hepático, e nos Grupos 3 e 4 os animais foram submetidos a 30 minutos de isquemia sem clampleamento do ducto biliar. Os animais dos Grupos 2 e 4 receberam 150mg.Kg-1 de NAC, endovenoso, 15 minutos antes do procedimento. Colheu-se sangue antes do procedimento e após o clampeamento do pedículo para a dosagem enzimática. Amostras de fígado foram coletadas para dosagem de glutationa, microscopia óptica e eletrônica. No estudo estatístico aplicaram-se testes não paramétricos, p < 0,05. RESULTADOS: O aumento das enzimas foi menor quando se administrou NAC, sendo semelhante na ausência do clampeamento da via biliar. À microscopia óptica houve diferença significante dos grupos S/NAC X C/NAC, mostrando que o grupo C/NAC manteve a arquitetura do parênquima durante a isquemia, independente do clampeamento do ducto biliar. Na microscopia eletrônica os grupos C/NAC e os sem clampeamento do ducto biliar apresentaram arquitetura celular preservada. A NAC não alterou a relação de glutationa reduzida/ glutationa oxidada (GSH/GSSG). CONCLUSÕES: A NAC é capaz de proteger o parênquima hepático durante a isquemia normotérmica e propõe-se que o mecanismo seja por reação direta da NAC com o óxido nítrico (NO).FURG Departamento de CirurgiaUNIFESP-EPM Departamento de CirurgiaUSP Departamento de Análises Clínicas e ToxicológicasUNIFESP-EPM Departamento de Medicina InternaUNIFESP-EPM Departamento de MorfologiaUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPM Depto. de Medicina InternaUNIFESP, EPM Depto. de MorfologiaSciEL

Hyperinsulinism assessment in a sample of prepubescent children

OBJETIVOS: Determinar a relação entre o índice de massa corporal (IMC), o homeostasis model assessment - insulin resistance (HOMA-IR) e a insulinemia. MÉTODOS: Realizou-se um estudo observacional prospectivo transversal com 132 crianças pré-púberes em idade escolar e residentes no município de Santo André (SP). Fez-se a avaliação antropométrica e a mensuração da glicemia, da insulinemia e do índice HOMA-IR. RESULTADOS: Dentre as 132 crianças avaliadas, 78 eram meninas (59,1%) e 54 eram meninos (40,9%), com média de idade de 8,7 anos e média de IMC de 13,7 kg/m². Observou-se uma associação significativa e positiva entre HOMA-IR e IMC, insulina e IMC, peso e HOMA e entre insulina e peso; também foi constatado que, quanto maior for o IMC, maior será o valor de HOMA. CONCLUSÕES: Os resultados do presente estudo permitem concluir que há uma forte associação entre o hiperinsulinismo e a obesidade, devendo ser tomadas algumas medidas para evitar o ganho de peso durante a infância e a adolescência.OBJECTIVES: To determine the relationship between body mass index (BMI), homeostasis model assessment - insulin resistance (HOMA-IR) and insulinemia. METHODS: This was a prospective cross-sectional observational study of 132 prepubescent schoolchildren residents in the municipality of Santo André, Brazil. Children underwent anthropometric assessment, their glycemia and insulinemia were measured and their HOMA-IR index calculated. RESULTS: Seventy-eight of the 132 children (59.1%) were girls and 54 were boys (40.9%), with a mean age of 8.7 years and mean BMI of 13.7 kg/m². A significant positive association was detected between HOMA-IR and BMI, insulin and BMI, weight and HOMA and between insulin and weight. It was also found that the higher the BMI, the greater the HOMA score. CONCLUSIONS: The results of this study allow for the conclusion that there is a strong association between hyperinsulinism and obesity. Measures should be taken to avoid weight gain during childhood and adolescence

Hyperinsulinism assessment in a sample of prepubescent children

OBJECTIVES: To determine the relationship between body mass index (BMI), homeostasis model assessment - insulin resistance (HOMA-IR) and insulinemia. METHODS: This was a prospective cross-sectional observational study of 132 prepubescent schoolchildren residents in the municipality of Santo André, Brazil. Children underwent anthropometric assessment, their glycemia and insulinemia were measured and their HOMA-IR index calculated. RESULTS: Seventy-eight of the 132 children (59.1%) were girls and 54 were boys (40.9%), with a mean age of 8.7 years and mean BMI of 13.7 kg/m². A significant positive association was detected between HOMA-IR and BMI, insulin and BMI, weight and HOMA and between insulin and weight. It was also found that the higher the BMI, the greater the HOMA score. CONCLUSIONS: The results of this study allow for the conclusion that there is a strong association between hyperinsulinism and obesity. Measures should be taken to avoid weight gain during childhood and adolescence.OBJETIVOS: Determinar a relação entre o índice de massa corporal (IMC), o homeostasis model assessment - insulin resistance (HOMA-IR) e a insulinemia. MÉTODOS: Realizou-se um estudo observacional prospectivo transversal com 132 crianças pré-púberes em idade escolar e residentes no município de Santo André (SP). Fez-se a avaliação antropométrica e a mensuração da glicemia, da insulinemia e do índice HOMA-IR. RESULTADOS: Dentre as 132 crianças avaliadas, 78 eram meninas (59,1%) e 54 eram meninos (40,9%), com média de idade de 8,7 anos e média de IMC de 13,7 kg/m². Observou-se uma associação significativa e positiva entre HOMA-IR e IMC, insulina e IMC, peso e HOMA e entre insulina e peso; também foi constatado que, quanto maior for o IMC, maior será o valor de HOMA. CONCLUSÕES: Os resultados do presente estudo permitem concluir que há uma forte associação entre o hiperinsulinismo e a obesidade, devendo ser tomadas algumas medidas para evitar o ganho de peso durante a infância e a adolescência.Faculdade de Medicina do ABC Programa de Mestrado em CiênciasUniversidade de São Paulo Instituto de QuímicaUniversidade Federal de São Paulo (UNIFESP)UNIFESP Departamento de Ciências BiológicasUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)FMABC Departamento de Pediatria Serviço de NutrologiaUSP Faculdade de MedicinaFMABC Laboratório de Análises ClínicasUNIFESP, Depto. de Ciências BiológicasUNIFESP, EPMSciEL

Satisfaction level of phisicians working in a social health organization of Unified Health System In Brazil

Introduction: The evaluation of a work system is based on the ability to adapt work to the man and the man to the work. One of the aspects that interfere in the capacity of adaptation is the satisfaction in the work as the integration, the autonomy, the motivation, the involvement and the utilization of the physical and mental capacities.Objective: To analyze the level of satisfaction of medical professionals regar ding their work environment in a Social Health Organization of Brazilian Unified Health System.Methods: It is a cross-sectional, exploratory and descriptive study. For data collection, we used a questionnaire mailed  through the Google Docs platform, containing 36 questions about indicators: material, personnel, quality and social.Results: A total of 51 physicians participated in the study. The findings showed significant associations between their satisfaction of work environment and relationship with their work team, unit manager and performance recognition.Conclusion: The satisfaction in the work environment of the medical professional in the Social Health Organization is associated with internal factors, as well as the need for their performance recognition by the management policy. The external factors studied, such as multiple job sites