Abstract The aim of this study was to describe the prevalence, clinicopathological, and prognostic features of acinic cell carcinoma (AciCC) of the oral and maxillofacial region. AciCC cases were retrospectively retrieved from 11 pathology centers of three different countries. Medical records were examined to extract demographic, clinical, pathologic, and follow-up information. A total of 75 cases were included. Females (65.33%) with a mean age of 45.51 years were mostly affected. The lesions usually presented as an asymptomatic (64.28%) nodule (95.66%) in the parotid gland (70.68%). The association of two histopathological patterns was the most common finding (48.93%) and the tumors presented mainly conventional histopathological grades (86.11%). Surgical treatment was performed in the majority of the cases (59.19%). Local recurrence was observed in 20% of the informed cases, regional metastasis in 30.43%, and distant metastasis in 12.50%. The statistical analysis showed that the cases with a solid histopathological pattern (p=0.01), high-grade transformation (p=0.008), recurrence (p=0.007), and regional metastasis (p=0.03) were associated with poor survival. In conclusion, high histopathological transformation, presence of nodal metastasis, and recurrence were prognostic factors for AciCC of the oral and maxillofacial region. prevalence clinicopathological (AciCC region 1 countries demographic clinical pathologic followup follow up information 7 included 65.33% 6533 65 33 (65.33% 4551 45 51 45.5 affected 64.28% 6428 64 28 (64.28% 95.66% 9566 95 66 (95.66% 70.68%. 7068 70.68% . 70 68 (70.68%) 48.93% 4893 48 93 (48.93% 86.11%. 8611 86.11% 86 (86.11%) 59.19%. 5919 59.19% 59 19 (59.19%) 20 3043 30 43 30.43% 1250 12 50 12.50% p=0.01, p001 p p=0.01 , 0 01 (p=0.01) highgrade grade p=0.008, p0008 p=0.008 008 (p=0.008) p=0.007, p0007 p=0.007 007 (p=0.007) p=0.03 p003 03 (p=0.03 survival conclusion 65.33 653 6 3 (65.33 455 4 5 45. 64.28 642 2 (64.28 95.66 956 9 (95.66 706 70.68 (70.68% 48.93 489 (48.93 861 86.11 8 (86.11% 591 59.19 (59.19% 304 30.43 125 12.50 p00 p=0.0 (p=0.01 p000 p=0.00 00 (p=0.008 (p=0.007 (p=0.0 65.3 (65.3 64.2 (64.2 95.6 (95.6 70.6 (70.68 48.9 (48.9 86.1 (86.11 59.1 (59.19 30.4 12.5 p0 p=0. (p=0.00 (p=0. 65. (65. 64. (64. 95. (95. 70. (70.6 48. (48. 86. (86.1 59. (59.1 30. 12. p=0 (p=0 (65 (64 (95 (70. (48 (86. (59. p= (p= (6 (9 (70 (4 (86 (59 (p ( (7 (8 (5

Resumo Bartonella é um gênero de bactérias zoonóticas emergentes associadas principalmente a eritrócitos e células endoteliais de mamíferos. Morcegos são reservatórios naturais para uma variedade de patógenos importantes que afetam a saúde humana e animal. Além disso, estudos recentes destacaram o papel dos morcegos e de moscas associadas a morcegos na manutenção de Bartonella. No presente estudo, nenhuma das 29 amostras de DNA obtidas a partir do sangue de cinco espécies de morcegos amostrados na ilha de São Luís, estado do Maranhão, Nordeste do Brasil, foi positiva para Bartonella nos ensaios de qPCR direcionados ao gene nuoG. Por outro lado, três das 15 (20%) amostras de DNA de moscas da família Streblidae foram positivas para Bartonella. Os resultados do BLASTn mostraram que as sequências dos genes gltA e rpoB compartilharam identidade, variando de 97,2% a 100%, com as sequências de Bartonella amplificadas em morcegos ou moscas amostrados na Costa Rica ou Brasil. Tais resultados corroboraram as análises filogenéticas realizadas por Inferência Bayesiana. O presente estudo mostrou a ocorrência de Bartonella em moscas de morcegos, auxiliando a esclarecer a distribuição dos genótipos de Bartonella relacionadas a moscas Streblidae na América do Sul.

Abstract Bartonella is a genus of emerging zoonotic bacteria that are mainly associated with mammalian erythrocytes and endothelial cells. Bats are natural reservoirs for a variety of important pathogens that impact human and animal health. Recent reports have highlighted the role of bats and bat flies in the maintenance of Bartonella. Here, we showed that none of the 29 bat DNA blood samples obtained from five bat species in São Luís Island, state of Maranhão, northeastern Brazil, were positive for Bartonella in qPCR assays targeting nuoG. On the other hand, three out of 15 DNA samples (20%) from flies in the family Streblidae were positive for Bartonella. The BLASTn results showed that the gltA and rpoB sequences shared identities ranging from 97.2% to 100%, with Bartonella sequences amplified from bats or bat flies from Costa Rica and Brazil. These findings were supported by phylogenetic analyses based on Bayesian inferences. The present study showed that Bartonella genotypes are present in bat flies, thus shedding some light on the distribution of bat fly-related Bartonella genotypes in South America.

INTRODUÇÃO: Apresenta-se raro caso de fístula vésico-apendicular secundária a adenocarcinoma mucinoso do apêndice. RELATO DE CASO: Paciente masculino de 62 anos com história de um ano de infecções urinárias de repetição. Após dois meses desenvolveu pneumatúria e fecalúria, sendo indicada tomografia computadorizada de abdômen que mostrou massa trans-mural na parede da bexiga, com fistula vésico-entérica para região do íleo terminal. A laparotomia revelou tumoração surgindo do apêndice cecal, em continuidade com a parede posterior da bexiga. A mesma foi aberta, sendo identificada grande fistula e material tumoral até próximo ao trígono vesical. A biópsia de congelação identificou adenocarcinoma mucinoso. Realizada hemicolectomia associada à cistectomia parcial em bloco, com preservação do trígono vesical. Houve extravasamento de mucina para a cavidade pélvica pela manipulação. Optado por lavagem peritoneal com solução de mitomicina a 42º C para prevenir disseminação peritoneal. O paciente evoluiu com íleo prolongado pós-operatório, tendo alta hospitalar no15º dia. Cinco meses após o procedimento encontrava-se em quimioterapia com 5-fluouracil e leucovorin, sem sinais de doença recidivante. CONCLUSÃO: A presença de fístula vésico-apendicecal é extremamente rara, tendo poucos casos relatados na literatura. O conhecimento dos diferentes tipos de neoplasias e seus tratamentos adequados permite ao cirurgião oferecer melhor cuidado ao paciente.

BACKGOUND: A rare case of vesicoappendiceal fistula secondary to mucinous adenocarcinoma of the appendix is presented. CASE REPORT: A 62-year-old man with a one year history of recurrent urinary tract infections. After two months he developed pneumaturia and fecaluria. An abdominal and pelvic computed tomography demonstrated a trans-mural mass in the posterior wall of the bladder with a vesicoenteric fistula leading to the terminal ileum. Laparotomy revealed a tumor arising from the appendix contiguous with the bladder posterior wall. The bladder was opened and a large fistula and tumor on the posterior bladder wall near the trigone was identified. Frozen pathological analysis showed a mucinous adenocarcinoma. En-bloc right hemicolectomy and partial cystectomy, preserving bladder trigone was performed. After manipulating the tumor, grossly leakage of mucinous materials occurred into the pelvic cavity. A peritoneal washing with a mytomicin solution at 42º C was then performed, to prevent peritoneal seeding. The patient had a prolonged postoperative ileus and was discharged at the 15th day. Five months after the procedure the patient was recieving chemotherapy with 5-fluoracil and leucovorin and there was no signs of recurrent disease. CONCLUSION: The presentation with vesico-appendiceal fistula is extremely rare with only a few cases reported in the literature. Knowledge of different types of neoplasm and appropriate treatment allows the surgeon to provide patients optimal care referring to specialized centers whenever appropriate.

OBJETIVO: A litíase urinária é uma complicação incomum no alotransplante renal, a incidência varia de 0,02 a 3,4%. A maioria dos cálculos forma-se após o transplante, porém alguns podem ser transferidos junto com o enxerto para o hospedeiro. O tratamento desta complicação está baseado em alguns casos descritos na literatura. O objetivo deste trabalho é o de relatar a incidência da litíase renal no paciente com transplante renal, assim como a conduta adotada no HCFMRPUSP. MÉTODOS: Foram analisados 953 pacientes submetidos a transplante renal no HCFMRPUSP, de fevereiro 1968 a maio de 2003. A idade média foi de 47,2 anos (35 a 63 anos). Em 09 pacientes, o rim foi proveniente de doador cadáver e apenas 01 doador vivo. RESULTADOS:Foram diagnosticados 10 casos de litíase (1,05%). Em 02 pacientes (20%) o cálculo foi diagnosticado no intraoperatório, em 01 (10%) no peri-operatório (5º. dia), os 07 restantes (70%) no pós-operatório tardio. Em 04 pacientes (57%) não havia sintomatologia específica, 02 (29%) apresentaram ITU, em 03 (43%) ocorreu elevação da creatinina sérica. De 8 pacientes com litíase no pós-operatorio, em 06 os cálculos estavam localizados no rim e 02 no ureter. Dos pacientes com cálculos renais, 02 foram observados, 02 submetidos a LECO, 01 a nefrolitripsia percutânea, 01 à pielolitotomia. Em 01 paciente com cálculo ureteral foi realizada pielovesicostomia (cálculo + estenose), no outro paciente foi feita a ureterorrenoscopia retrógrada. CONCLUSÃO: A urolitíase é complicação rara no transplante renal, a conduta terapêutica no pós-operatório tardio é semelhante à da população geral.

Purpose: Urinary lithiasis is an uncommon complication in recipient of kidney allografts. The prevalence varies from 0.02 to 3.4%. The majority of calculi arises de novo in the recipient, however some of them are transferred with the transplanted kidney. The treatment relies on few reports published previously. The aim of the study is to determine the prevalence of lithiasis as well as the treatment in an university hospital. METHODS: We analyzed 953 recipients of renal transplant undertaken in Hospital das Clínicas - FMRP-USP, from February of 1968 to May of 2003. The mean age of patients bearing lithiasis was 47.2 years (range 35 to 63 years). RESULTS: The prevalence of lithiasis was 10/953 (1.0%). Nine patients received kidneys from cadaver donor and 1 from living donor. The diagnosis occurred during the surgery in 2 (20%), within few days after transplantation in 1 (10%) and in the late postoperative period in 7 (70%). Seven patients had no complains, 2 had associated urinary tract infection and 1 a rise in serum creatinine. Of 8 cases with lithiasis in the postoperative period, the stones were localized in the kidney in 6 and in the ureter in 2. Renal calculi were managed as follows: watchful-waiting - 2, extracorporeal lithotrypsy - 2, percutaneous nepholithotrypsy - 1 and open pyelolithomy - 1. One patient with ureteric lithiasis associated ureteral stenosis underwent a pyelo-vesicostomy. The other patient with ureteric lithiasis was treated by retrograde endoscopic ureterolithothrypsy. CONCLUSION: Urinary lithiasis is rare in transplanted kidneys and can be managed as to the general population.