Giant cell tumor of the tendon sheath (GCTTS) is the second most common tumor of the hand after ganglion cysts (1,2). It is a slowly growing, usually painless benign lesion of soft tissues. The tumor affects individuals between the age of 30 and 50 years old and is found more often in women than men (3-6). Despite its benign character, local recurrence after excision has been reported in up to 45% of cases (7); there isn't still a defined treatment protocol and local excision with or without radiotherapy is the treatment of choice to date (1,2,7-13).We made a retrospective study of literature of the last 15 years and evaluated the demographic, clinical and histological aspects of the GCTTS of the hand and compared the results with our experience in a series of 64 cases from 2000 to 2012 to assess the factors that mostly contribute to incidence and recurrence of this tumor. Patients and methodsWe searched for published articles regarding the GCTTS from 1998 using the PubMed search engine. The keywords used were as follows: "giant cell tumor, tumor tendon, hand tumor"; all retrieved papers were analysed and their reference list were also screened if relevant. For each report, information was gathered on characteristics of the trial and study population, location and multicentricity of lesion, kind and severity of symptoms. We also recorded the applied treatment modality, histopathological examination of the excised tumor and recurrence rate.A retrospective study was conducted in our Department of Plastic and Reconstructive Surgery and all data were collected from medical records of 64 GCTTS patients within this Department from 2000 to 2012. Medical record included the age, gender, tumor location, presentation and size, clinical features, treatment modality, histopathological report and neurovascular or tendon involvement.All cases were operated under tourniquet control, using a magnifying loupe. Special care was taken to excise the tumor in total, retaining the capsule, if present, with margin of normal tissue. The operating field is searched for presence of satellite lesions.The histopathological diagnosis and immunohistochemical studies were conducted by the Department of Pathology within the same Hospital. Follow-up ranged from 2-153 months.

Objective: To identify the perception of medical students and physicians on the importance of vaccination and the risks of vaccine refusal.Methods: Cross-sectional study with application of questionnaires about vaccines, vaccine refusal and its repercussions on public and individual health. A sample of 92 subjects was selected from a private medical school: group 1 (53 students from first to fourth grades) and group 2 (39 physicians). Data collected were tabulated in the Microsoft Excel Program and analyzed by Fisher’s exact test.Results: Both groups considered the National Immunization Program reliable and recognized the importance of vaccines, but 64.2% of students and 38.5% of physicians are unaware of the vaccine-preventable infectious diseases in the basic immunization schedule. Most of the interviewees had a personal vaccine registry, but not all had received the 2015 influenza vaccine. Both groups had known people who refused vaccines for themselves or for their children (respectively, 54.7 and 43.3% of students and 59.0 and 41.0% of physicians). The total of 48.7% of physicians had already assisted vaccine refusers. Appointed causes of vaccine refusal were: fear of adverse events, philosophical and religious reasons and lack of knowledge about severity and frequency of diseases. Ethical aspects of vaccine refusal and legal possibilities of vaccine requirements for children are not consensus.Conclusions: Medical students and doctors are not adequately vaccinated and have queries about the vaccination schedule, vaccine safety and vaccine refusal. Improving these professionals’ knowledge is an important strategy to maintain vaccine coverage and address vaccine refusal ethically.

According to the Brazilian Association of Organ Transplants, in 2015, 19,408 bone transplants were performed in Brazil, over 90% by Dental Surgeons. The surgical technique itself has a respectable number of reports regarding its clinical efficacy, as measured by long-term survival of dental implants in grafted areas. Uncertainty remains, however, as to whether fresh frozen grafts from human bone donors remain immunologically innocuous in the body of the host. Six male with no previous medical history of note, including systemic diseases, surgery or blood transfusion were selected. These patients underwent reconstructive procedures (sinus lifting) using fresh frozen human bone from a tissue bank. All patients had venous blood samples collected prior to surgery and 6 months after the procedure. Anti-HLA analysis for the detection of HLA (human leukocyte antigen) antibodies was performed using methods such as the LABScreen PRA Class I and Class II, LABScreen Single Antigen Class I and Class II, Luminex Platform. Reactive individuals to the screening tests (LABScreen PRA) were further investigated to determine the specificity of the antibodies detected (LABScreen Single Antigen) with a cutoff value of median fluorescence intensity ≥500. As a result, it was observed that two patients (33%) were positive in screening tests, one presenting with anti-HLA Class I and II sensitization and the other with anti-HLA class II. The specificity analysis showed that the patients sensitized to HLA class II presented 4 specificities, 3 of which immunologically relevant. In the second individual, 23 specificities were identified, 6 of which immunologically important for HLA class I and 4 specificities for HLA class II, 3 of these were immunologically important. All specificities detected had average fluorescence. These findings are suggestive that sinus-lifting procedures with allogeneic bone can induce immunological sensitization.

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There is a statistically association between DM and LUTS on Elder men, evaluated through a specific questionnaire.

Resumo Resultados nulos, negativos ou inesperados são ocorrências possíveis para pesquisadores em todo o mundo. Não publicar tais resultados representa desperdício de recursos (de tempo, dinheiro e esforços). O objetivo deste estudo foi avaliar, mediante aplicação de questionário, o que estudantes de medicina e médicos pensam sobre a publicação de resultados inesperados ou negativos em pesquisa e discutir os aspectos éticos da questão. As questões foram respondidas por 40 alunos e 30 médicos de uma faculdade privada de medicina. Conclui-se que ainda é pouco discutida e aceita a publicação de resultados negativos ou inesperados, persistindo a crença que publicar tais resultados pode prejudicar a reputação dos pesquisadores. Quase todos os participantes acreditam ser importante a publicação desse tipo de resultados, mas apenas cerca de 60% os publicariam. Torna-se, então, importante e necessário ampliar a discussão sobre o assunto nas escolas médicas para se criar nova mentalidade acadêmica.

Objective: To evaluate intraoperative graft patency and identify grafts under risk of early occlusion.Methods: Fifty four patients were submitted to coronary artery bypass surgery and the graft flow was assessed by the Flowmeter (Medtronic Medistim), which utilizes the TTFM method. Three patients had left main disease and 48 had normal or mildly reduced left ventricular function.Results: In hospital mortality was 3.7% (two patients), one for mesenteric thrombosis and one due to cardiogenic chock. Seventeen patients (34%) were submitted to off pump CABG. Arterial Graft flow measures ranged from 8 to 106 ml/min (average 31.14 ml/min), and venous grafts flow ranged from 9 to 149 ml/min (average 50.42 ml/min).Conclusion: Flowmeter use represents higher safety both for patients and surgeons. Even under legal aspects, the documentation provided by the device can avoid future questionings. Bras Cir Cardiovasc 2012;27(3):401-4 Descriptors

RESUMO Diminuir as iniquidades na assistência