Objective: To determine the role of urine cytology for ‘decoy cells’ as a screening tool for polyomavirus type BK (BKV) infection in renal transplant recipients. Study Design: This was a prospective cohort study of patients undergoing renal transplantation between 2006 and 2010. Results: A total of 442 patients underwent urine cytology for decoy cells, 27.8% underwent 1 examination only and 72.2% more than one. Of the 1,713 examinations reviewed, 426 (24.9%) were positive and 785 (45.8%) were negative for ‘decoy’ cells, 380 (22.2%) showed degenerated tubular cells and 122 (7.1%) were unsatisfactory for analysis. Urine cytology was found to have a specificity of 68.5%, a sensitivity of 84.6%, a positive predictive value of 21.2%, a negative predictive value of 97.8% and an overall accuracy of 69.9%. The incidence of polyomavirus nephropathy among the patients investigated was 11.8%. Of the 442 patients, 32 (7.2%) had graft loss, which was attributed to BKV nephropathy in 2 (6.2% of the 32). Conclusions: Urine cytology is an effective screening method for monitoring renal transplant patients, with high sensitivity and a high negative predictive value, and can therefore be used routinely in the follow-up of renal transplant patients.

Bladder cancer (BCa) is the most frequent urinary tract neoplasm. BCa results in significant mortality when the disease presents as muscle invasive. Around 75% to 80% of patients present with nonmuscle invasive bladder cancer (NMIBC), but recurrence and progression are significant issues, compelling current guidelines to recommend long-term surveillance. There is therefore an urgent and unmet need to identify and validate accurate biomarkers for the detection of disease recurrence to improve quality of life for the patients and reduce costs for health care providers, while maintaining or improving current outcomes. In this review, 38 publications on immunohistochemistry prognostic biomarkers, that were studied may be related in nonmuscle invasive bladder cancer, have been analyzed. The studies were organized according to the evaluated marker and their findings. It was demonstrated that the combination of independent complementary biomarkers could allow a more accurate prognosis than an isolated marker. Biomarkers, including p53, Ki-67, and CK20, with classic and prognostic factors with recurrence and novel markers such as EN2 may provide a more accurate prediction of outcome compared with any single marker, improving risk stratification and clinical management of patients with BCa.

Bladder cancer (BC) is a heterogeneous neoplasia characterized by a high number of recurrences. Standardized clinical and morphological parameters are not always sufficient to predict individual tumor behavior. The aim of this study was to evaluate the expression of cell cycle regulators proteins as potential adjuvant in prognosis and monitoring of this disease. Block paraffin samples from patients with urothelial bladder carcinoma treated by transurethral resection (TUR) were collected to immunohistochemistry analysis for proteins p16, p21, p27, p53, pRb and Ki-67. Chisquare, logistic regression and Kaplan-Meier curve were used to analyze the prognostic value of these markers. Of the 93 patients included in the study, the main categories of staging observed were T1 (53%) and Ta (29%), and the distribution between tumor grades was 58% of patients with low grade to 42% of patients with high grade. The expressions of p16, p21, p27, p53, pRb and Ki-67 were altered in 31%, 42%, 60%, 91%, 27% and 56% of patients, respectively. The immunohistochemical expression of Ki-67 was associated with tumor histological grade (p = 0.016), and expression of pRb with recurrence-free survival (p = 0.035), but no isolated marker was significant associated with recurrence and progression in multivariate analysis. More than two markers abnormally expressed were associated with presence of recurrence (p = 0.005) and lower recurrence-free surviva (p = 0.004). Our panel marker has important prognostic value for BC, especially when more than two have altered expression predicting good clinical recurrence implication.

Objective: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. Methods: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related to the pleural metastasis. Results: We evaluated 145 patients, 87 (60%) of whom had tested positive for malignant cells in the pleural fluid. Ductal histology was observed in 119 (82%). The triple-negative breast cancer phenotype was seen in 25 cases (17%). Those patients had the worst prognosis (with a sharp decline in the survival curve), and 20 of the 25 (80%) died during the follow-up period (through June of 2011). The mean survival after the identification of malignant pleural effusion was 6 months. Conclusions: In patients with triple-negative breast cancer who test positive for malignant cells in the pleural fluid, the prognosis is poor and survival is reduced.Keywords: Pleural effusion, malignant/mortality; Breast neoplasms/mortality; Breast neoplasms/genetics. ResumoObjetivo: O objetivo deste estudo foi identificar os fatores clínicos e anatomopatológicos que possam influenciar o prognóstico de pacientes com câncer de mama e sintomas clínicos de derrame pleural neoplásico. Métodos: Trata-se de um estudo clínico de coorte, no qual foram analisados os prontuários médicos de pacientes que receberam diagnóstico de derrame pleural neoplásico entre 2006 e 2010. Por meio da análise dos prontuários, identificamos as pacientes com história de câncer de mama. Para essas pacientes, coletamos dados anatomopatológicos relacionados ao tumor primário e dados citopatológicos relacionados à metástase pleural. Resultados: Das 145 pacientes avaliadas, 87 (60%) apresentaram, no exame citológico, resultado positivo para células neoplásicas no líquido pleural; além disso, 119 (82%) apresentaram tipo histológico ductal. O fenótipo triplo-negativo foi observado em 25 pacientes (17%), as quais apresentaram o pior prognóstico, com queda acentuada na curva de sobrevida. Das 25 pacientes, 20 (80%) evoluíram a óbito durante o período de seguimento (até junho de 2011). A sobrevida média após a identificação de derrame pleural neoplásico foi de 6 meses. Conclusões: Em pacientes com câncer de mama triplo-negativo e exame citológico com resultado positivo para células neoplásicas no líquido pleural, o prognóstico é ruim e a sobrevida é menor. cancer who develop pleural effusion. To that end, we evaluated factors related to the diagnosis, the histological type of the primary tumor, the identification of malignant cells in the pleural fluid, the expression of immunohistochemical markers of breast cancer, and outcomes. MethodsThis was a hospital-based, historical cohort study...

Os acidentes ocupacionais são fenômenos socialmente determinados, indicativos da intensa rotina de trabalho à qual é submetida grande parte dos trabalhadores das áreas da saúde e culminam por constituir importante problema de saúde pública no Brasil, atingindo principalmente adultos jovens e causando elevado número de casos de invalidez e óbitos. No período do estudo, foram relatados no hospital escola 166 acidentes de trabalho, o que corresponde a 2,23% da população de estudo. Ao caracterizarmos os acidentes levando em consideração a categoria estudantil ou profissional, constatamos que os "Cursos Técnicos" são os que mais se envolvem em acidentes (31%), seguidos dos "Médicos Residentes" (28%) e dos "Acadêmicos de Medicina" (26%). A faixa etária mais relacionada a acidentes foi a de 20 a 29 anos, na qual está incluída a maioria dos estudantes, estagiários e médicos residentes, e o principal motivo relatado pelos acidentados foi o descuido próprio. As categorias profissionais, idade e causa do acidente evidenciam que medidas educativas devem ser tomadas para prevenção efetiva destes acidentes.

There were not enough strong morphological and staining elements to state the origin of the degenerated cells or to describe the nature of the infection (viral or bacterial), given that these cells were undergoing an apoptotic process in post renal transplant patients.

Editorial comments: Episodes of penile erection, and the stretching and yawning syndrome can be induced in experimental animals by CNS administration of adrenocorticotropin and alpha-melanocyte-stimulating hormone. Prior studies have suggested that melanotropic peptides act downstream to the actions of dopamine and oxytocin. The authors evaluated the erectogenic properties of Melanotan-II, cyclic alpha-melanocyte-stimulating hormone analogue. A group of ten men with no known organic cause of their erectile dysfunction were entered into the study, and the effects of Melanotan-II (given subcutaneously in the abdomen) were compared to placebo using real-time Rigiscan monitoring over a six-hour period. The authors reported a statistically significant greater number of erectile events, duration of erectile activity, degree of rigidity and tumescence activity units in the drug group versus the placebo. The drug had no effects on sexual desire. The side-effect profile was also higher in the Melanotan-II group, including stretching and yawning, nausea, decreased appetite and changes in skin pigmentation. This double-blind, crossover study is very sig-ni®cant in that it represents the ®rst placebocontrolled investigation documenting the positive erectogenic effects of an alpha-MSH analogue in humans. Interestingly, the activity and toxicity of Melanotan-II are similar to another centrally-acting erectogenic agent, apomorphine, which also acts on the dopaminergic system. The side-effect pro®le of Melanotan-II was signi®cant and may represent a limiting factor in its usefulness for the treatment of erectile dysfunction. Further studies in larger groups of individuals, including men and women, possibly utilizing different routes of administration may help us to better understand the activity of these peptides and help de®ne their role in the management of sexual dysfunction.

No abstract