Cervical and Vulvar Intraepithelial Neoplasia after Treatment with Oral Isotretinoin for Severe Acne Vulgaris

Oral isotretinoin is the drug of choice for severe acne vulgaris, but its use is still controversial in preventing, treating or stopping the progression of the cervical intraepithelial neoplasia [6, 7, 8]. It induces cell differentiation, inhibits cell proliferation, stimulates host immune reaction, inhibits the oncogene expression, augments cell-mediated cytotoxicity, and induces apoptosis [5]. The isotretinoin has many side effects including teratogenicity. There is no previous report of developing cervical intraepithelial neoplasia (CIN) or vulvar intraepithelial neoplasia (VIN) after introducing oral isotretinoin to a patient. We are reporting a 37-year-old female with no risk factors for cervical cancer who had developed CIN-I and VIN-I during a 6-month treatment period of oral isotretinoin for her severe acne vulgaris. Interestingly, the patient had complete spontaneous pathologic-proven remission after stopping the isotretinoin. Further case reports are warranted to support this incidence

Successful Treatment of Primary Vaginal Papillary Serous Adenocarcinoma Using Chemoradiation Followed by Brachytherapy

Advances in treatment have not recently been reported in rare primary vaginal adenocarcinomas. A 56-year-old woman with a chronic vaginal cyst and possible in utero diethylstilbestrol exposure presented with postmenopausal bleeding. Biopsy of the vagina revealed high-grade papillary serous adenocarcinoma. MRI showed a 6-cm vaginal tumor and 3-cm left inguinal lymph node with metastasis. The patient initially received concurrent cisplatin and radiation. She then received high-dose-rate brachytherapy for further local control. Brachytherapy following external beam radiation with concurrent cisplatin led to clinically undetectable cancer at 24 months with minimal side effects

Extramammary Perianal Paget's Disease

Perianal Paget's disease is a rare malignancy. It is rarely isolated and often associated with an underlying adenocarcinoma. It usually presents with anal itchiness and discomfort and can be misdiagnosed as hemorrhoids. Once the diagnosis of perianal Paget's disease is granted, extensive work-up to find an underlying primary malignancy is crucial. Surgery is the standard modality of treatment of extramammary Paget's disease (EMPD) with recurrence rates of 44–60%. Other different treatment modalities including radiotherapy, laser therapy, topical and systemic chemotherapy and the new emerging, promising photodynamic therapy are in the field of study. A 76-year-old man was referred to our hospital with a one-year history of anal itchiness and intermittent rectal bleeding. Skin shave and punch biopsies from the perianal area were reported back as perianal Paget's disease with no underlying adenocarcinoma. The immunohistochemical stains were positive for cytokeratin 7 but also positive for cytokeratin 20 and CEA which indicated the essentiality of extensive investigations to find a primary malignancy. Skin exam showed no primary source. The investigations were unable to find the primary malignancy. Given the results of immunohistochemical stains we recommended local perianal Paget's disease resection. The intraoperative frozen section showed adenocarcinoma around the anal sphincter. Ten days later the patient underwent an abdominoperineal resection and the final pathology report showed extensive adenocarcinoma in three quadrants of the perianal area with focal involvement of the rectal mucosa. We recommended an adjuvant chemotherapy with FOLFOX following surgery given the bulkiness of the disease. We conclude that once perianal Paget's disease is diagnosed, an extensive work-up should be done to find the underlying primary malignancy. Immunohistochemical stains are helpful in raising the suspicion of underlying primary malignancy. Finding an underlying primary malignancy in patients with EMPD is prompt to choose the treatment modality and estimate the prognosis

Geotecnologias nos estudos geológicos e geotécnicos para suporte à gestão ambiental no litoral norte do RS (Brasil): um panorama de duas décadas.

O objetivo deste trabalho foi comparar os dados disponíveis, bem como as técnicas e os softwares utilizados há duas décadas frente ao que hoje está disponível para produzir mapas temáticos, empregando dados vetoriais e de imagens e integrando os mesmos num sistema de informações geográficas (SIG)

ANÁLISE DO POTENCIAL ENERGÉTICO RENOVÁVEL BASEADO EM SISTEMAS DE INFORMAÇÃO GEOGRÁFICA: CASO DO LITORAL NORTE, RS

The present study aims to present a methodology based on GIS to identify and locate the renewable energy potential as a contribution to sustainable energy exploration in coastal zones. The developed methodology was applied to North Littoral of Rio Grande do Sul, including 17 municipalities. A database was developed containing thematic layers of coverage and land use, hydrography, geology/geomorphology, digital terrain model (DTM), insolation, solar radiation, wind energy potential, and statistical information about population, agricultural production and electrical energy consumption. Processes of spatial selection, attributes selection, reclassification, overlays, and qualitative and quantitative analyses were applied in order to creating a general table of the predominant energy sources, the diversification of the energy matrix and the possible harnessing potential. The results show that all of the coastal municipalities offer at least two renewable energy sources that can be exploited, fourteen of which possess very high or high renewable energy potential.Este artigo apresenta uma metodologia baseada em SIG para identificação e localização do potencial energético renovável a fim de contribuir com a exploração energética sustentável nas zonas costeiras. A metodologia desenvolvida é aplicada no Litoral Norte do Rio Grande do Sul, com área total de 4.469 km2 e abrange 17 municípios. Foi elaborado um banco de dados contendo layers temáticos de cobertura e uso da terra, hidrografia, geologia/geomorfologia, modelo digital de elevação (MDE), insolação, radiação solar, potencial eólico e informações estatísticas de população, produção agrícola e consumo de energia elétrica. Procedimentos de análise espacial, seleção de atributos, reclassificação, overlays e análises qualitativas e quantitativas foram aplicados, com vistas à criação de um quadro geral das fontes renováveis predominantes, da diversificação da matriz energética e do possível potencial de aproveitamento. Os resultados indicam que todos os municípios litorâneos apresentam pelo menos duas fontes de energia renovável passíveis de aproveitamento (resíduos de biomassa, pequenas hidrelétricas, solar e eólica) e 14 deles possuem alto ou ouito alto potencial energético renovável