Mucosal melanomas of the head and neck are very rare malignancies that present with aggressive behavior and poor prognosis. Usually diagnosed at advanced stages, thus presenting macroscopically as aggressive nodular neoplasms arising from the mucosa; few cases are detected in situ. Tumor staging for mucosal melanoma remains a challenge. Several staging systems have been suggested, including tumornodal-metastases (TNM) staging systems, but none are frequently used. There is no clear consensus on the management of head and neck mucosal melanoma, which reflects the rare nature of the disease and complexity of the anatomic site. The late diagnosis, frequently presenting at an advanced stage, denotes the aggressive nature of the disease. Currently, early detection and surgical excision is considered the primary method of treatment. The multidisciplinary team approach can help reduce morbidity and mortality once optimize treatment, reduce costs and minimize adverse events, while maximizing the chances of recovery.
Purpose: To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model. Methods: New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21 st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed. Results: All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P<0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gammaglutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P<0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis. Conclusion: Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.
Purpose: To evaluate whether undergraduate students feel motivated to develop surgical skills and know their impression about the importance of having a surgical technique discipline in the curriculum of a medical school. Methods: A prospective study including three classes in a row, from the 8th period (n = 265) evaluated the knowledge acquired at the Center of Experimental Surgery, Department of Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ). The importance of the discipline for medical training as a way of encouragement to arouse and deepen the interest in surgical technique was emphasized. The questions were scored from 1 to 5 (worst to best grade). Results: Concerning the importance of the discipline for medical training, 78% and 18% of the students assigned a score 5 and 4, respectively. Regarding the stimulus to improve their surgical technical skills, 40% and 32% attributed the score 5 and 4, respectively. Conclusion: Undergraduate students from the Medical School of UFRJ effectively shared the understanding that the operative technique bases improve the formative process with significant impact, not only in the development of skills, but also to arouse vocations and stimulate new attitudes aimed to knowledge acquirement in the field of Surgery.
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