ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

RESUMO Objetivo: Avaliar a relação entre os hábitos tabágicos e a evolução de pacientes com carcinoma urotelial de bexiga superficial. Métodos: Foi realizado um estudo retrospectivo com 99 pacientes (67,0 ± 13,2 anos, variando de 31,4-93,4 anos, 72,7% homens e 27,3% mulheres) tratados de carcinoma urotelial de bexiga não-invasivo entre 1994 e 2000, com seguimento médio de 49,3 meses (4,0-177,9 meses). Os pacientes foram divididos em tabagistas e não-tabagistas, e os tabagistas foram subestratificados entre ex-tabagistas, interruptores precoces, interruptores tardios e tabagistas persistentes. O principal desfecho avaliado foi a progressão para doença invasiva. Resultados: O tabagismo foi mais comum entre os homens (p = 0,03), sendo que 62,6% do total de pacientes avaliados eram tabagistas. O diagnóstico do câncer ocorreu em uma idade mais precoce entre os tabagistas (70,8 versus 64,8 anos, p = 0,03). Observou-se uma progressão significativamente maior para doença invasiva entre os pacientes com carga tabágica acima de 60 maços/ano (52,9 versus 26,2%, p = 0,037). Estes pacientes tiveram um tempo de progressão de 59,3 versus 131,8 meses para aqueles com menor carga tabágica. Conclusões: Há associação direta entre a carga tabágica e progressão do carcinoma urotelial de bexiga para doença músculo-invasiva em um curto intervalo de tempo. Estudos prospectivos e com maior número de pacientes são necessários para entender como a interrupção do tabagismo afeta a progressão do carcinoma superficial de bexiga.

ABSTRACT Objective: To evaluate the association between smoking habits and outcome of patients with superficial bladder cancer. Methods: A retrospective study was performed evaluating 99 patients (67.0 ± 13.2 years, ranging from 31.4-93.4 years, 72.7% males and 27.3% females) treated at our institution with non muscle-invasive bladder cancer, between 1994 and 2000, with a mean follow-up of 49.3 months (range 4.0-177.9 months). Patients were divided according to smoking status, and the main measured outcome was progression to invasive disease. Additional cohort analysis was performed dividing patients according to previous tobacco exposure: smokers and non-smokers. Smokers were stratified into former smokers, early-quitters, late quitters and continued smokers. Results: Smoking habit was significantly more common in males (p = 0.03). Cancer also occurred at an earlier age among smokers (70.8 versus 64.8 years, p = 0.030). Tobacco consumption was present in 62.7% of the patients with bladder cancer. There was a significant higher progression rate to muscle-invasive disease in patients that had more than 60 pack-years of exposure (52.9 versus 26.2%, p = 0.037). These patients had a mean progression time of 59.3 months, whereas patients who had smoked less than 60 pack-years progressed after a mean time of 131.8 months. Conclusions: A direct association between the amount of tobacco consumed and disease progression is observed in patients with bladder cancer, as suggested by the present study. Tobacco consumption has a direct association with progression of superficial bladder cancer to invasive disease and also shortens the period of time for muscle invasion. Larger and prospective studies are still necessary to bring further definitive conclusions about reproducibility of our data and to better understand how smoking cessation affects progression of superficial bladder cancer.

(Coléteres foliares e calicinais de Temnadenia violacea (Apocynaceae, Apocynoideae): estrutura e distribuição). Este trabalho descreve a origem, estrutura e posição dos coléteres dos ápices vegetativos e florais de Temnadenia violacea (Vell.) Miers e comprova a presença de mucilagem na secreção produzida por estas estruturas. O número de coléteres foliares varia de 9 a 11 por primórdio e de 18 a 22 por nó; apenas um tem origem axilar, sendo os demais de origem marginal. Quanto à posição, cinco coléteres são peciolares e os demais interpeciolares. Os coléteres foliares são dos tipos standard e séssil, sendo constituídos por uma porção alongada, formada por um núcleo central de células parenquimáticas, revestido por epiderme secretora em paliçada uniestratificada e cutícula delgada. Tricomas tectores e tecido vascular ocorrem apenas nos coléteres marginais distais. No ápice floral, os coléteres calicinais têm origem na base do cálice, sendo três coléteres opostos a cada uma das lacínias. Todos os coléteres calicinais possuem um núcleo central de células parenquimáticas, epiderme secretora em paliçada uniestratificada, cutícula delgada e são sésseis; o eixo parenquimático destes coléteres é destituído de vascularização e os laticíferos observados são de pequeno calibre. A mucilagem foi detectada tanto na secreção dos coléteres foliares quanto dos calicinais.

(Foliar and calycine colleters of Temnadenia violacea (Apocynaceae, Apocynoideae): structure and distribution). The present work describes the origin, structure and position of the colleters on vegetative and floral apices of Temnadenia violacea (Vell.) Miers and confirms the presence of mucilage in the secretion produced by those structures. The number of foliar colleters ranges from 9 to 11 per primordium and from 18 to 22 per node; only one has an axilar origin, while the others originate along the margins. Concerning position, five of them are petiolar and the others are interpetiolar. There are two types of foliar colleters: standard and sessile, and they consist of a main body composed of a central core of elongated parenchyma cells surrounded by a secretory palisade epidermis and a thin cuticle. Tector trichomes and vascular tissue occur only on the distal marginal colleters. On the floral apices, the calycine colleters are formed at the base of the calyx, three of them opposite the sepals. All of the calycine colleters have a central core of elongated parenchyma cells, a secretory palisade epidermis, a thin cuticle, and are sessile. The calycine colleters are not vascularized and the laticifers are narrow. Mucilage was detected in the secretion of both foliar and calycine colleters.

Vários materiais são propostos para reconstrução nasal, não havendo consenso sobre qual o melhor. A manta de celulose produzida por bactéria pode ser mais um elemento para adição cartilaginosa. Não há estudos deste material no dorso nasal. OBJETIVO: Avaliar a resposta tecidual à presença da celulose bacteriana no dorso nasal de coelhos. MATERIAL E MÉTODO: Foram utilizados 22 coelhos Nova Zelândia, sendo que em 20 deles foi implantada a manta de celulose no dorso nasal e em 2 controles nada foi feito. Foram acompanhados por um período de três e seis meses, sendo então retirados as regiões do dorso nasal e narinas dos coelhos e realizado estudo histopatológico levando em consideração parâmetros definidos de condição inflamatória como congestão vascular, intensidade do processo inflamatório e presença de exsudato purulento. RESULTADOS: O processo inflamatório manteve-se estável, demonstrando sua relação com o procedimento cirúrgico, e não com a presença da manta de celulose. Nos demais parâmetros estudados não houve diferença estatisticamente significante. CONCLUSÃO: A manta de celulose de Acetobacter xylinum mostrou boa biocompatibilidade e manteve-se estável no decorrer do tempo de estudo, podendo ser considerada um bom material para uso na elevação do dorso nasal.

Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. AIM: to study tissue reaction to cellulose in the dorsal nose of rabbits. MATERIALS AND METHODS: 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. RESULTS: The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. CONCLUSION: The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.

Laticíferos ocorrem em todos os representantes de Apocynaceae e são considerados não articulados ramificados pela maioria dos autores; entretanto, laticíferos articulados têm sido descritos para algumas espécies da família. O presente trabalho tem por objetivo descrever a ontogênese, estrutura, distribuição e o tipo dos laticíferos em órgãos vegetativos de Fischeria stellata (Vell.) E.Fourn., Gonioanthela axillaris (Vell.) Fontella & E.A. Schwarz, Matelea denticulata (Vahl) Fontella & E.A. Schwarz e Oxypetalum banksii Schult. e reavaliar os laticíferos de Asclepias curassavica L. de mata atlântica, comparando os resultados aos de espécies de cerrado. Os laticíferos das cinco espécies são articulados anastomosados, cujas paredes transversais ou oblíquas são dissolvidas rápida e integralmente. Os laticíferos ramificam-se através de anastomose lateral e formam um sistema contínuo por todos os órgãos da planta adulta. Eles são observados em todos os tecidos primários do caule e da folha, excetuando-se a epiderme, e no tecido vascular secundário, exceto no xilema secundário de A. curassavica. A ontogênese destes laticíferos pode explicar a divergência entre os nossos dados e aqueles publicados para a grande maioria das espécies desta família. Os resultados obtidos evidenciam que a ontogênese, estrutura e distribuição dos laticíferos das espécies de Asclepiadeae de floresta de restinga, floresta ombrófila densa de terras baixas e cerrado são semelhantes. A continuidade do sistema laticífero articulado anastomosado permite um maior afluxo de látex ao local injuriado, pois o conteúdo das regiões interconectadas é liberado simultaneamente, coagulando e selando os ferimentos rapidamente, além de impedir a entrada de microorganismos.

Laticifers occur in all members of Apocynaceae. They are described as nonarticulated branched by most authors, but articulated laticifers have been reported to some species of this family. The present study aims to describe the laticifer ontogeny, structure, distribution, and type in vegetative organs of Fischeria stellata (Vell.) E.Fourn., Gonioanthela axillaris (Vell.) Fontella & E.A. Schwarz, Matelea denticulata (Vahl) Fontella & E.A. Schwarz, and Oxypetalum banksii Schult. and re-evaluate the laticifers of Asclepias curassavica L. from Atlantic rainforest, comparing the results with those of species from "cerrado" vegetation. The laticifers of these five species are articulated anastomosing, whose transverse or oblique walls dissolve rapidly and entirely. The laticifers branch through lateral anastomoses and form a continuous system throughout the adult plant. They are observed in primary tissues of stem and leaf, except in epidermis; they are also present in the secondary vascular tissue, except in the secondary xylem of A. curassavica. The ontogeny of these laticifers may explain the divergence between our data and those recorded for most species of the family. The results obtained revealed that the ontogeny, type, structure, and distribution of laticifers of the species of Asclepiadeae from "restinga", lowland humid forests, and "cerrado" vegetation are similar. The continuity of the articulated anastomosing laticifer system ensures a greater latex flow into the injured organ, releasing the laticifer exsudate simultaneously, coagulating and sealing the wounds rapidly, besides hindering the entrance of microorganisms.

A criação de modelos de estudo das rinossinusites é necessária para compreensão de seus aspectos fisiopatológicos. OBJETIVO: Sugerimos neste estudo estabelecer um modelo experimental fidedigno, reproduzível e consistente para a rinossinusite inflamatória sem uso de inoculação de agentes infecciosos em coelhos. Tipo de Estudo: Experimental. MATERIAL E MÉTODO: Foram utilizados 20 coelhos neste estudo. Os animais foram submetidos a 4 intervenções diferentes: colocação de tampão de esponja unilateral, obliteração unilateral de óstio nasal com cianoacrilato, instilação unilateral de antígenos em seio maxilar e instilação de sangue em cavidade maxilar unilateral. Os animais foram acompanhados até 15 dias do início do estudo e ao final do período de seguimento foram anestesiados e sacrificados. Os seios maxilares foram avaliados histologicamente e os resultados comparados com os seios maxilares contralaterais para controle e entre os grupos de intervenção. RESULTADOS: Todos os animais do estudo desenvolveram rinorréia amarelada unilateral até o 15º dia de acompanhamento. Apenas os animais que receberam sangue não apresentaram alterações histológicas compatíveis com rinossinusite purulenta. CONCLUSÕES: O uso de esponja e cola para obstrução do óstio meatal e a aplicação de toxóide são eficientes como produtores de modelo de rinossinusite. A aplicação de sangue no antro não produz os mesmos resultados.

Experimental models for clinical studies of rhinosinusitis are needed. AIM: to define a reliable, solid and reproducible experimental model for inflammatory rhinosinusitis with no innoculation of infectious agents in rabbits. Study design: Experimental. MATERIAL AND METHOD: Twenty 20 rabbits were divided into 4 groups submitted to 4 different interventions: the placement of a unilateral nasal fossa sponge, unilateral obliteration of the nasal ostium with cyanoacrylate, unilateral placement of antigens in the maxillary cavity and unilateral placement of blood in the maxillary cavity. The animals were monitored for 15 days and then anesthetized and sacrificed; the maxillary sinuses were evaluated histologicaly and results were compared with controls and between the intervention groups. CONCLUSION: Sponje and glue as agents of meatal obstruction and toxoid aplied in the antrum are efficient as methods for rhinosinusitis modeling. Blood was not efficient in producing sinusitis.

OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT) in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70% were males and 30% females, with mean age of 65 ± 16 years (ranging from 31 to 91 years). Nineteen patients presented renal pelvis tumor (58%), 9 ureteral tumor (27%) and 5 synchronic pelvic and ureteral tumors (15%). Renal pelvis tumors represented 2.8% of all the urothelial neoplasms, and 11.4% of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6% of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40%, much lower than found in most of the reported series.