This study demonstrates the good prognosis of MIC, regardless the treatment. When fertility is not a concern, hysterectomy should be considered as definitive treatment to avoid the risk of residual disease. Regular follow-up for a long period should be maintained.

A elevada prevalência de sofrimento psíquico presente nos estudantes de medicina, pode acarretar em transtornos mentais, uso de substâncias psicoativas e comportamentos prejudiciais, além de impactar no aprendizado. Estes fatores levaram a Faculdade de Ciências Médicas da Unicamp à criação de um serviço de apoio (GRAPEME) para os seus discentes em 1996. No decorrer dos anos, o GRAPEME sofreu diversas mudanças tanto na sua estrutura física e de recursos humanos, como nas diversas formas de atuação. Atualmente conta com o atendimento individual mas também com iniciativas de intervenções precoces e prevenção, a fim de minimizar o sofrimento e melhorar a qualidade de vida de seus alunos.

Objectives:We compared the indication of laparoscopy for treatment of adnexal masses based on the risk scores and tumor diameters with the indication based on gynecology-oncologists' experience.Methods:This was a prospective study of 174 women who underwent surgery for adnexal tumors (116 laparotomies, 58 laparoscopies). The surgeries begun and completed by laparoscopy, with benign pathologic diagnosis, were considered successful. Laparoscopic surgeries that required conversion to laparotomy, led to a malignant diagnosis, or facilitated cyst rupture were considered failures. Two groups were defined for laparoscopy indication: (1) absence of American College of Obstetrics and Gynecology (ACOG) guideline for referral of high-risk adnexal masses criteria (ACOG negative) associated with 3 different tumor sizes (10, 12, and 14 cm); and (2) Index of Risk of Malignancy (IRM) with cutoffs at 100, 200, and 300, associated with the same 3 tumor sizes. Both groups were compared with the indication based on the surgeon's experience to verify whether the selection based on strict rules would improve the rate of successful laparoscopy.Results:ACOG-negative and tumors ≤10 cm and IRM with a cutoff at 300 points and tumors ≤10cm resulted in the same best performance (78% success = 38/49 laparoscopies). However, compared with the results of the gynecology-oncologists' experience, those were not statistically significant.Discussion:The selection of patients with adnexal mass to laparoscopy by the use of the ACOG guideline or IRM associated with tumor diameter had similar performance as the experience of gynecology-oncologists. Both methods are reproducible and easy to apply to all women with adnexal masses and could be used by general gynecologists to select women for laparoscopic surgery; however, referral to a gynecology-oncologist is advisable when there is any doubt.

This study suggests that laparoscopy for the diagnosis and treatment of adnexal masses is safe and does not increase complication rates even in patients who need conversion to laparotomy. However, when doubt about the safety of the procedure and about the presence of malignancy persists, consultation with an expert gynecology-oncologist with experience in advanced laparoscopy is recommended. A large tumor diameter was associated with the necessity of conversion to laparotomy.

Introdução: A formação do médico implica na aquisição de conhecimento, habilidades, e atitudes que são desenvolvidas ao longo do curso e a avaliação tem um papel fundamental para garantir a qualidade desse processo. A escolha do instrumento de avaliação muitas vezes é influenciada pela disponibilidade de estrutura física, tecnológica e de recursos humanos. Na educação médica a maioria das disciplinas trabalham com diagnóstico por imagem, e, portanto, as provas possuem um volume grande de imagens e, consequentemente um custo alto para impressão das mesmas. Outro aspecto a ser considerado são as avaliações que demandam maior complexidade na correção, como os portfólios. O objetivo deste estudo é relatar a estratégia adotada na gestão do curso para apoiar o processo de avaliação da aprendizagem.

Despite recent efforts to understand the complex process of medical career and specialty choice, medical education community has a low understanding of why, how and when doctors make their choices. This information can be an important tool to identify obstacles and orientation in relation to career counseling among students.

No abstract

Objective: to assess the prevalence of residual disease in hysterectomy specimens after conization in women treated for squamous microinvasive carcinoma of the uterine cervix (MIC). A cohort of 607 patients with MIC diagnosed and treated at Campinas State University, Brazil was analyzed. All patients underwent cervical conization and of these, 388 followed by hysterectomy. Residual carcinoma / CIS in the hysterectomy was highly associated with positive endocervical conization margins (p<0,0001), in 171 cases of free conization endocervical margins, 32/171 (18.7%) had residual disease: 20 CIS (11.7%), and 12 MIC (7%).Positive endocervical margins are highly associated with residual disease in hysterectomy specimen (61.1%) so further treatment is mandatory. Conservative treatment should be carefully evaluated.