In this paper is established a spongy bone bidimensional models methodology for its analysis by finite element software. The models are focused to represent the bone trabecular structure by Voronoi cells, using the coordinates of the porous center, contained within the bone structure, obtained by optical microscope images. Looking for a better geometrical similarity, it was assigned a thicker transversal area in the trabecula union zone, because has been reported that this factor gives a better approximation to experimental results. To feed the finite element models, compression test has been done to trabecular specimens, taking the maximum strain and maximum stress, to obtain the elastic modulus. By means of strained specimen images analysis, it has been established the structure collapse moment. It was when the 36% of total trabeculae failed. Finally it was obtained a tissue Young modulus of 323 [MPa] and with this value, the resistance variation in function of density and trabecular architecture.

En este trabajo se establece una metodología para generar modelos bidimensionales de hueso esponjoso, que son analizados mediante paquetería de elemento finito.Los modelos están enfocados a representar la arquitectura trabecular mediante celdasde Voronoi, a partir de las coordenadas de los centros de los poros de la estructura ósea observados en imágenes generadas mediante microscopía óptica. Buscando similitud geométrica, se asignó un mayor espesor en la zona de unión de las trabéculas, ya que se ha comprobado que esta consideración lleva a resultados más aproximados a los experimentales. Para nutrir el modelo se realizaron pruebas de compresión a probetas de hueso trabecular, tomando los valores de deformación máxima y esfuerzo máximo para determinar la rigidez del tejido. Mediante el análisis de imágenes de probetas deformadas, se estableció que el momento del colapso de la estructura trabecularse da por la sucesión de fallas enlas trabéculas individuales y se determinó un valor crítico de aproximadamente un 36% de las trabéculas. Finalmente, se determinó mediante análisis por elemento finito, que la rigidez del tejido esponjoso es de 323[MPa], y a partir de este valor se evaluó la variación de la resistencia en función de la densidad y la arquitectura trabecular.

Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.

In contrast to most developed countries, most patients with primary hyperparathyroidism in Brazil are still symptomatic at diagnosis. However, we have been observing a change in this pattern, especially in the last few years. We evaluated 104 patients, 77 females and 27 males aged 11-79 years (mean: 54.4 years), diagnosed between 1985 and 2002 at a University Hospital. Diagnosis was made on the basis of clinical findings and of high total and/or ionized calcium levels, high or inappropriate levels of intact parathyroid hormone and of surgical findings in 80 patients. Patients were divided into three groups, i.e., patients diagnosed from 1985 to 1989, patients diagnosed from 1990 to 1994, and patients diagnosed from 1995 to 2002. The number of new cases diagnosed/year increased from 1.8/year in the first group to 6.0/year in the second group and 8.1/year in the third group. The first group comprised 9 patients (mean serum calcium ± SD, 13.6 ± 1.6 mg/dl), 8 of them (88.8%) defined as symptomatic. The second group comprised 30 patients (mean calcium ± SD, 12.2 ± 1.63 mg/dl), 22 of them defined as symptomatic (73.3%). The third group contained 65 patients (mean calcium 11.7 ± 1.1 mg/dl), 34 of them symptomatic (52.3%). Patients from the first group tended to be younger (mean ± SD, 43.0 ± 15 vs 55.1 ± 14.4 and 55.7 ± 17.3 years, respectively) and their mean serum calcium was significantly higher (P < 0.05). All of symptomatic patients independent of group had higher serum calcium levels (12.4 ± 1.53 mg/dl, N = 64) than asymptomatic patients (11.4 ± 1.0 mg/dl, N = 40). Our data showed an increase in the percentage of asymptomatic patients over the years in the number of primary hyperparathyroidism cases diagnosed. This finding may be due to an increased availability of diagnostic methods and/or to an increased awareness about the disease.

Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70ºC for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8% in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89% 30 min after total parathyroidectomy and cure was observed in 85.7%. THP showed an average IO-PTH decrease of 91.9%, and cure was obtained in 87.5% of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP.

OBJETIVO: Relato de três casos do GLLM acompanhados pela Disciplina de Hematologia e Hemoterapia da Unifesp-EPM que tiveram boa resposta à terapêutica e evolução favorável. MÉTODOS: Após confirmação histológica e histoquímica, os pacientes foram submetidos à tratamento quimio e radioterápico com boa resposta terapêutica. RESULTADOS: Atualmente estes pacientes encontram-se em remissão total da doença, com sobrevida média de 45 meses. CONCLUSÃO: Levando-se em consideração nossa pequena experiência, acreditamos que o tratamento radioterápico e a abordagem quimioterápica inicial agressiva são fundamentais para uma boa evolução deste tipo de linfoma.

PURPOSE: We report three cases of LMG followed at Disciplina de Hematologia e Hemoterapia from Unifesp-EPM with good response to conventional treatment and favorable outcome. METHODS: After histological and histochemical analyses, patientes were treatd with combined chemo-and radiotherapy with favorable evolution. RESULTS: Currently they present clinical complete remission, with mean survival of 45 months. CONCLUSION: Despite of our small experience, we believe that combined aggressive therapy is extremely important for further favorable evolution in this type of lymphoma.