RESUMO INTRODUÇÃO: A sialoendoscopia vem se tornando o procedimento de referência para o diagnóstico e o tratamento das doenças inflamatórias da glândula salivar. OBJETIVO: Avaliar a progressão de aprendizado de um mesmo cirurgião para implementação e realização da sialoendoscopia diagnóstica: verificar quantos procedimentos foram necessários para a obtenção de resultados melhores e se houve ocorrência de maior taxa de complicações no início do aprendizado. MÉTODO: Análise retrospectiva envolvendo 113 sialoendoscopias consecutivas realizadas de 2010 a 2013. De acordo com uma análise descritiva dos fatores relacionados à experiência do cirurgião, a casuística foi dividida em dois grupos: grupo (A), compreendendo os primeiros 50 exames; e grupo (B), os últimos 63. Em seguida, os grupos foram comparados, levando em consideração os aspectos demográficos e perioperatórios. RESULTADOS: No grupo A, a não realização do cateterismo papilar foi de 22% vs. 3% em B (p = 0,001). A não realização de um exame completo foi de 30% no grupo A vs. 6% em B (p = 0,001), e a necessidade de repetir o exame foi de 22% no grupo A vs. 10% em B (p = 0,058). Os percentuais de complicações foram 18% no grupo A e 10% em B (p = 0,149). O tempo operatório foi ligeiramente menor no grupo B (56 vs. 41 minutos, p = 0,045). CONCLUSÃO: Verificamos melhores desfechos após as 50 primeiras sialoendoscopias diagnósticas. Os percentuais de complicações foram estatisticamente semelhantes entre os grupos inicial e avançado de experiência com a sialoendoscopia.

ABSTRACT INTRODUCTION: Sialendoscopy is becoming the gold standard procedure for diagnosis and treatment of Salivary Gland Inflammatory Diseases. OBJECTIVE: To evaluate the learning progression of a single surgeon to implement and perform diagnostic sialendoscopy: to estimate how many procedures were necessary to achieve better results; if it was higher rate of complications in the beginning. METHODS: Retrospective analysis involving 113 consecutive sialendoscopies performed from 2010 to 2013. According to a descriptive analysis of the factors related to surgeon's experience, the casuistic was divided into two groups: group (A) comprising the first 50 exams, and group (B) the last 63. Groups were then compared concerning demographic and peri-operative aspects. RESULTS: In Group A, failure to catheterize papilla were 22% versus 3% in B (p = 0.001). Failure to complete examination was 30% in group A versus 6% in B (p = 0.001), and necessity to repeat exams was 22% in group A versus 10% in B (p = 0.058). The complication rates were 18% in group A, and 10% in B (p = 0.149). Operative time was slightly shorter in group B (56 versus 41 min, p = 0.045). CONCLUSION: We found better outcomes after the first 50 diagnostic sialendoscopies. Complication rates were statistically the same between early and late groups of experience with sialendoscopy.

Sessenta isolados de oriundos de Colletotrichumcampos de produção de banana dos Municípios de Vicência, São VicenteFérrer e Machados, no Estado de Pernambuco, foram avaliados quanto a características morfológicas,moleculares, culturais, de virulência e de diversidade genética. Os isolados foram identificados como C. musae, tendo a maioria conídios retos, oblongos, com ápices arredondados. A taxa de crescimento micelial variou de1,36 a 1,91 cm/dia. Foram encontrados três grupos de coloração para as colônias: branca, creme e salmão,enquanto a presença de setores variou de 0 a 8 por isolado e, na maioria dos isolados (73,3%), houve a presença de microescleródios. A diferença em virulência foi significativa para a área abaixo da curva de progresso da doença, indicando variabilidade entre os isolados. O dendrograma gerado pela análise UPGMA dos marcadores ISSR–PCR revelou a formação de três grupos pelo coeficiente de similaridade de Dice, os quais correspondem, na sua maioria, às três áreas amostradas.

Sixty Colletotrichum isolates originating from fields producing banana in the municipalities of Vicência, São Vicente Férrer and Machados in the State of Pernambuco were evaluated for physiological, morphological, molecular, cultural, virulence and genetic diversity characteristics. The isolates were identified as C. musae, with most conidia, straight, oblong with rounded summits. The mycelial growth rate ranged from 1.36 to 1.91 cm / day. Three groups of staining for colonies were found: white, cream and salmon, while the presence of sectors ranged from 0 to 8 per isolate, and in most isolates (73.3%) there were the presence of microsclerotia. The difference in virulence was significant for the area under the disease progress curve, indicating variability among isolates. The dendrogram generated by UPGMA analysis of ISSR-PCR markers revealed the formation of three groups by Dice similarity coefficient which correspond mostly to the three sampled areas.

Hypercalcemia is found frequently in patients with cancer. Besides the etiology related to the malignancy, other causes should be considered in the differential diagnostic, as primary hyperparathyroidism, granulomatous diseases and the use of thiazide diuretics. We present a case report of a severe hypercalcemia due to a rare association and review the relevant literature. A female patient, 57 years old, sent to the Endocrinology Service of Hospital das Clínicas da Universidade do Paraná (SEMPR) in order to investigate severe hypercalcemia with frequent need of hospitalization. The patient was in chemotherapy treatment for recurrence of clear cell renal cancer. During the investigation she presented high level of parathyroid hormone (PTH) and parathyroid scintigraphy suggestive of hyperplasia/ adenoma of parathyroid, histopathological diagnosis was confirmed after parathyroidectomy. After surgery the patient presented undetectable levels of PTH. However, she continued with progressive increase of serum calcium, with no signs of bone metastases or change in vitamin D metabolism. The investigation showed high levels of PTH-related protein (PTHrP), leading us to the diagnosis of hypercalcemia of malignancy. The patient presented severe hypercalcemia due to the rare association of primary hyperparathyroidism and humoral hypercalcemia of malignancy due to secretion of PTHrP by tumor cells. The presence of isolated primary hyperparathyroidism, as a cause of hypercalcemia in cancer patients, has been described in approximately 5-10% of the patients. However, the association of primary hyperparathyroidism and humoral hypercalcemia of malignancy (which means with concomitant elevation of PTH and PTHrP) is rare, only three cases have been described in the literature. Arch Endocrinol Metab. 2015;59(1):84-8

INTRODUCTION: Automatic detection of blood components is an important topic in the field of hematology. Segmentation is an important step because it allows components to be grouped into common areas and processed separately. This paper proposes a method for the automatic segmentation and classification of blood components in microscopic images using a general and automatic fuzzy approach. METHODS: During pre-processing, the supports of the fuzzy sets are automatically calculated based on the histogram peaks in the green channel of the RGB image and the Euclidean distance between the leukocyte nuclei centroids and the remaining pixels. During processing, fuzzification associates the degree of pertinence of the gray level of each pixel in the regions defined in the histogram with the proximity of the leukocyte nucleus centroid closest to the pixel. The fuzzy rules are then applied, and the image is defuzzified, resulting in the classification of four regions: leukocyte nuclei, leukocyte cytoplasm, erythrocytes and blood plasma. In post-processing, false positives are reduced and the leukocytes (including the nucleus and cytoplasm), erythrocytes and blood plasma are segmented. RESULTS: A total of 530 microscopic images of blood smears were processed, and the results were compared with the results of manual segmentation by experts and the accuracy rates of other approaches. CONCLUSION: The method demonstrated average accuracy rates of 97.31% for leukocytes, 95.39% for erythrocytes and 95.06% for blood plasma, avoiding the limitations found in the literature and contributing to the practice of the segmentation of blood components.

INTRODUÇÃO: A core biopsy (CB) tem ganhado espaço cada vez mais importante no diagnóstico e no manejo do câncer de mama devido a seu baixo custo e alta acurácia. Entretanto, devemos nos perguntar se esse método realmente é adequado para a caracterização do tipo histológico e do grau de diferenciação tumoral, uma vez que a região biopsiada pode não ser representativa do tumor como um todo. OBJETIVO: Avaliar a concordância entre o anatomopatológico da biópsia e o encontrado na peça cirúrgica. MATERIAL E MÉTODOS: Realizamos um estudo retrospectivo envolvendo todos os pacientes com câncer de mama submetidos à mastectomia radical modificada ou à quadrantectomia em nosso serviço, entre janeiro de 2007 a dezembro 2009, analisando a taxa de concordância entre o resultado da CB do tumor de mama e o anatomopatológico da peça cirúrgica. Estudamos como variáveis o tipo histológico e o grau de diferenciação tumoral e de invasão linfovascular. RESULTADOS: Os resultados mostraram taxa de concordância para tipo histológico de 76% entre os métodos. Já a concordância para o grau tumoral foi de 50%, observando-se uma tendência da CB a subestimar o grau. Em relação à presença de invasão linfovascular, ocorreram 62,09% de concordância, sendo 100% seu valor preditivo positivo (VPP), mas com baixa sensibilidade (29%). CONCLUSÃO: Esses achados sugerem que a CB seja o método adequado para o diagnóstico histológico do câncer de mama, porém apresenta alta taxa de discordância para grau tumoral e invasão linfovascular com o exame anatomopatológico da peça cirúrgica, tendendo a subestimar a agressividade do tumor.

INTRODUCTION: Core biopsy (CB) has increasingly gained importance in the diagnosis and management of breast cancer due to its cost effectiveness and high accuracy. However, it is debatable whether this method is particularly suitable for the characterization of histological type and tumor differentiation, since the biopsied region may not be representative of the tumor as a whole. OBJECTIVE: To evaluate the concordance between the biopsy and the surgical specimen anatomopathological findings. MATERIAL AND METHODS: We carried out a retrospective study involving all patients with breast cancer undergoing modified radical mastectomy or quadrantectomy in our service from January 2007 to December 2009, thus analyzing the concordance rate between the results of breast tumor CB and surgical specimen anatomopathology. Histological type, tumor differentiation grade and lymphovascular invasion were assessed as variables. RESULTS: The results show a concordance rate of 76% for the histological type between both methods. As to tumor grade, concordance rate was 50%, in which CB was prone to underestimate grade. Regarding the presence of lymphovascular invasion, the concordance was 62.09%, with 100% positive predictive value but low sensitivity (29%). CONCLUSION: These findings suggest that CB is a suitable method for histological diagnosis of breast cancer, although it has a high discordance rate for tumor grade and lymphovascular invasion in comparison with specimen anatomopathologic exam, tending to underestimate tumor aggressiveness.

Pilocarpus riedelianus was studied in order to obtain compounds with activity against fungi and bacteria. The dichloromethane extract, the most active one, was chromatographed yielding hexane and dichloromethane fractions. Six known sesquiterpenes, alpha-calacorene, beta-calacorene, gamma-calacorene, cadalene, sesquichamaenol and 1-hydroxy-1,3,5-bisabolatrien-10-one were identified in the hexane fractions. The identification of these compound was done by NMR and GC/MS analyses. The hexane fraction from the dichloromethane extract showed activity against several fungi and bacteria.