Abstract Objective To analyze the outcomes of a cohort of patients with high-risk histologies of endometrial cancer (EC) treated at Instituto Nacional de Câncer (National Cancer Institute, INCA, in Portuguese), in Brazil. Materials and Methods We reviewed the medical records of patients with high-risk histologies of EC in any stage registered at INCA between 2010 and 2016 to perform a clinical and demographic descriptive analysis and to evaluate the outcomes in terms of recurrence and survival. Results From 2010 to 2016, 2,145 EC patients were registered and treated at INCA, and 466 had high-grade histologies that met the inclusion criteria. The mean age of the patients was 65 years, 44.6% were Caucasian, and 90% had a performance status of 0 or 1. The most common histology was high-grade endometrioid (31.1%), followed by serous carcinoma (25.3%), mixed (20.0%), carcinosarcoma (13.5%), and clear cell carcinoma (9.4%). Considering the 2018 Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics, FIGO, in French) staging system, 44.8%, 12.4%, 29.8%, and 12.9% of the patient were in stages I, II, III or IV respectively. Age (> 60 years), more than 50% of myoinvasion, higher stage, poor performance status, serous and carcinosarcoma histologies, and adjuvant treatment were independent factors associated with recurrence-free survival (RFS) and overall survival (OS) in the multivariate analysis. Conclusion The current findings reinforced the international data showing poor outcomes of these tumors, especially for serous and carcinosarcomas and tumors with advanced stages, with shorter survival and high recurrence rates in distant sites, independently of the FIGO stage. Adjuvant therapy was associated with better survival.

Resumo Objetivo Analisar os desfechos de uma coorte de pacientes com câncer de endométrio (CE) e histologias de alto risco atendida no Instituto Nacional do Câncer (INCA) entre 2010 e 2016. Materiais e Métodos Foram revisados prontuários de pacientes com histologias de alto risco de CE em qualquer estágio cadastradas no INCA entre 2010 e 2016 para realizar uma análise descritiva clínica e demográfica e avaliar os resultados em termos de recorrência e sobrevida. Resultados De 2010 a 2016, 2.145 pacientes com CE foram cadastradas e atendidas no INCA, e 466 tinham histologias de alto grau e atendiam aos critérios de inclusão. A média de idade das pacientes foi de 65 anos, 44,6% eram brancas, e 90% tinham performance status de 0 ou 1. A histologia mais comum foi endometrioide de alto grau (31,1%), seguida de carcinoma seroso (25,3%), misto (20,0%), carcinossarcoma (13,5%) e carcinoma de células claras (9,4%). Considerando o estadiamento da Fédération Internationale de Gynécologie et d'Obstétrique (Federação Internacional de Ginecologia e Obstetrícia, FIGO, em francês) de 2018, 44,8%, 12,4%, 29,8% e 12,9% apresentaram estágios I, II, III ou IV, respectivamente. Idade (> 60 anos), mais de 50% de mioinvasão, estágio avançado, performance status ruim, histologias serosas e carcinossarcoma, e tratamento adjuvante foram fatores independentes associados à sobrevida livre de recorrência e sobrevida global na análise multivariada. Conclusão Os achados atuais reforçam os dados internacionais que demonstram o prognóstico ruim desses tumores, principalmente para as histologias serosas e carcinossarcomas e para estágios avançados, com menor sobrevida e altas taxas de recorrência à distância, independentemente do estágio da FIGO. A terapia adjuvante foi associada a melhor sobrevida.

SUMMARY OBJECTIVE: Cancer imposes a profound burden on low- and middle-income countries where 65% of the global cancer deaths occurred in 2020. The objective of the present review was to describe female cancer epidemiology in Brazil, barriers to prevention, screening, and treatment, and to propose strategies to a better control. METHODS: For the process of literature search and scientific acquisition, we have utilized the terms “female cancer” AND “breast cancer,” AND “cervical cancer” AND “endometrial cancer” AND “ovarian cancer” AND “Brazil” in PubMed. References of the articles included in this review were manually searched in order to identify relevant studies on the topic. The official Brazilian epidemiology data were extensively analyzed at the governmental site www.inca.gov.br. RESULTS: Considering cases of breast and gynecologic cancers together, 105,770 new cases are expected to be diagnosed yearly, positioning female cancer as the highest cancer incidence in Brazil. Female breast cancer is the most common and the leading cause of death from cancer in the female population in all regions of Brazil, except in the North, where cervical cancer ranks first. Cervical cancer, a preventable disease, corresponds to the third-most common neoplasia in women, with higher incidences in the North and Northeast regions of Brazil. An upward trend has been observed in endometrial cancer incidence, a tendency that follows the increase of its two most common risk factors: population aging and obesity. Ovarian cancer currently occupies the eighth position among female cancers in Brazil, but it is the most lethal gynecologic cancer. The main strategies to reduce female cancer mortality rates are the reduction of inequalities in healthcare services and the early diagnosis of cases. The lack of a specific national cancer program results in a reactive and unplanned approach to healthcare provision, ultimately leading to suboptimal resource utilization and higher expenditure. CONCLUSION: Analyzed together, breast and gynecologic cancers correspond to the leading cause of cancer in Brazil. A heterogeneous group, female cancer includes diseases with a high primary and secondary prevention potential. The organization of a female cancer program in Brazil prioritizing primary and secondary prevention strategies, such as adequate mammography screening and human papillomavirus vaccination coverage, could significantly improve female cancer control in the country.

RESUMO Objetivos: Avaliar a captação do gadolínio (Gd) à ressonância magnética (DCRM) em modelo experimental de lesão do tendão de Aquiles. Métodos: Foram utilizados 12 coelhos machos, adultos e brancos da raça Nova Zelândia, distribuídos em dois grupos: operados (n = 8), com ressecção da porção central do tendão de Aquiles; e o grupo controle (n=4). Após quatro semanas, realizou-se ressonância magnética com técnica de avaliação dinâmica do meio de contraste, seguido de analise histológica dos tendões. Resultados: Houve diferença (p <0,001) do pico máximo de realce de contraste, na DCRM dinâmica do tendão de Aquiles entre os grupos operado e controle, sendo evidenciada maior captação de contraste no grupo operado. À histologia, os tendões operados apresentaram desorganização de sua arquitetura, fibras tendíneas de aspecto desordenado, com neoformação vascular e proliferação de fibroblastos. Conclusão: A DCRM apresentou potencial de demonstrar alterações do padrão de vascularização do tendão de Aquiles no pré e pós-operatório. A DCRM apresenta potencial para ser usada em estudos para controle de tratamento e diagnóstico da tendinose. Nível de evidência II, Estudo Experimental.

ABSTRACT Objective: This study aimed to evaluate the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the experimental model of Achilles tendon injury. Methods: Twelve white male adults New Zealand rabbits were divided into two groups, a group with resection of the central portion of the Achilles tendon (n = 8) and a control group (n = 4). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed 4 weeks after the surgical procedure, followed by histological analysis of the tendons. Results: The main finding of this study was the difference (p < 0.001) in peak contrast enhancement on DCE-MRI, which demonstrated that the operated group had greater contrast uptake. The operated tendons showed histological disruption of their architecture, and cluttered appearance of tendinous fibers, with vascular and fibroblast proliferations. Conclusion: DCE-MRI is a technique with a potential to demonstrate changes in the vascularity pattern of the Achilles tendon before and after operation. DCE-MRI has a potential to be used in studies of tendinosis diagnosis and surgical follow-up. Level of evidence II, Experimental Study.

Este trabalho revisa e faz uma análise crítica da radiofrequência em oftalmologia. O aquecimento da córnea tem sido realizado desde 1889 com diferentes finalidades terapêuticas e cirúrgicas. O princípio do aquecimento da córnea causa um enrugamento do colágeno que muda a curvatura da córnea. Após a aprovação da FDA em 2004, iniciou-se um estudo multicêntrico no Brasil coordenado pela Faculdade de Medicina do ABC que resultou na análise de 258 pacientes. Como conclusão o estudo mostrou que o procedimento tem um resultado temporário e que os melhores resultados foram obtidos em pacientes entre 45 e 55 anos de idade sem correção óptica para longe. Acreditamos que o problema ainda não foi resolvido e que novas pesquisas devem ser realizadas.

This paper reviews and makes a critical analysis of radiofrequency in ophthalmology. Localized heating of the cornea has been apllied since 1889 for different therapeutic and surgical objectives.The principle that heating corneal tissue causes shrinking of the collagen that changes the corneal curvature. After the approval of FDA in 2004, we initiated a multicenter study in Brazil coordinated by ABC School of Medicine that resulted in an analyses of 258 patients. Inconclusion the study showed that the procedure had a temporary result and the best results were obtained in patients between 45 and 55 years old without optical correction for far.We believe that the problem has not been solved yet and a great deal of research effort should be focused.

O lúpus eritematoso sistêmico (LES) é uma doença crônica que acomete principalmente mulheres entre a terceira e quinta década de vida, multissistêmica, freqüentemente afetando os rins e o sistema nervoso central. Os sintomas relacionados ao trato gastrintestinal, apesar de comuns, quando ocorrem abrindo o quadro clínico, raramente levam ao diagnóstico por causa de sua baixa especificidade. Foi relatado um caso de LES cuja manifestação inicial foi diarréia crônica.

Systemic Lupus Erythematosus (SLE) is a chronic multissystemic disease that compromises women between the third and the fifth decade and frequently evolves the kidneys and the central nervous system. Gastrointestinal symptoms are usual however, when they appear as first symptoms, they rarely lead to lupus diagnosis for its low specificity. We report a case of SLE in which the initial manifestation was diarrhea.

OBJETIVOS: Verificar as alterações topográficas em córneas de olhos suínos enucleados após aplicações de radiofreqüência. MÉTODOS: Foi utilizado um protótipo produtor de radiofreqüência, com 10 diferentes possibilidades de potência. Para cada potência foram utilizados 10 olhos de porco enucleados que foram topografados pré e pós-aplicação de radiofreqüência seguindo nomograma com 8 pontos na primeira fase, 16 pontos na segunda fase, e 24 pontos na terceira fase, somando 3 fases para cada olho, num total de 300 aplicações e 400 topografias. RESULTADOS:Ocorreram variações da curvatura corneana após as aplicações de radiofreqüência para todas as potências utilizadas, demonstradas pela variação das médias de KM (dioptria mínima) inicial e KM final (35,78 e 37,37, respectivamente) com uma variação de 1,59 dioptrias (p< 0,001). A potência que apresentou maior regularidade foi de 0,625W/s (65ºC). CONCLUSÃO: Os valores topográficos obtidos demonstram que na média houve aumento da curvatura corneana central após aplicação de radiofreqüência em olhos de porco enucleados, e que quanto maior a energia utilizada e maior número de aplicações, maior foi o encurvamento corneano, porém não respeitando um padrão homogêneo.

PURPOSE: To verify the topographical alterations in enucleated pig eye cornea after radiofrequency application. METHODS: A prototype radiofrequency modulator with 10 different energy possibilities was used. For each energy we used 10 enucleated pig eyes that were topographed before and after applyng radiofrequency, following a nomogram with 8 spots in step one, 16 spots in step 2, and 24 spots in step 3, in a total of 3 steps for each eye, 300 applications and 400 topographies. RESULTS: Corneal curvature variation occurred after radiofrequency applications for all utilized selections, demonstrated by the mean variation of initial KM (minimum dioptry) and final KM (35.78 and 37.37 respectively) with 1.59 dioptries of variation (p<0.001). The energy that demonstrated more stability was 0.625W/s (65ºC). CONCLUSION: The obtained topographic values demonstrated that the central corneal curvature increased after radiofrequency application, and the higher the energy and the more spots used, more curved became the cornea, despite homogeneity.