Objective: To show the experience of the Erasto Gaertner Hospital with hemipelvectomy surgery over a 10-year period. Methods: This was a retrospective study on 32 patients who underwent hemipelvectomy at Erasto Gaertner Hospital between 1998 and 2008, assessing clinical and surgical characteristics. Results: Among the 32 patients, 15 were female and 17 were male. The mean age was 37.94 years. Eight cases showed involvement of the neurovascular bundle: three were located in the iliac and extended to the thigh, two were in the acetabulum and extended to the thigh and three were in the acetabulum and pubis. Twenty-three cases presented a neurovascular bundle free from neoplasia: 11 were restricted to the iliac, six were in the acetabular region, two were in the pubic ramus and four extended to the whole hemipelvis bone. One case involved the iliac-femoral vessels: one in the pubic ramus. Seven cases of chondrosarcoma and four cases of Ewing's sarcoma represented the majority. Eight cases underwent external hemipelvectomy and 24 underwent internal hemipelvectomy (11 were type I; four were type II; two were type II + III; three were type III and four were type IV). Of these 24 cases, 13 did not have any reconstruction, 10 had a fibular graft and one had an iliacfemoral vein and artery prosthesis. Twenty-six surgeries were curative and six were palliative. There were 14 deaths. Survival of two and five years was seen in 11 and 10 cases, respectively. For six cases, less than two years had passed since the operation. Three cases were lost during follow-up. Conclusion: This study shows the experiences of an oncology reference service specializing in highly complex surgical treatment.

Abstract:The trichilemmal carcinoma is a rare tumor that usually occurs on sun-exposed skin, especially on the face, scalp, neck and back of hands, mainly in elderly subjects but commonly between the 4th and 9th decades of life. It is not a gender-based illness. This study shows a difficult to treat case of recurrent trichilemmal carcinoma on the same location of a basal-cell carcinoma previously treated with surgery and radiotherapy. Keywords: Neoplasms, adnexal and skin appendage; Neoplasms, radiation-induced; Skin neoplasms Resumo: O carcinoma triquilemal é um tumor raro, que ocorre, geralmente, na pele exposta ao sol, principalmente face, couro cabeludo, pescoço e dorso das mãos, em indivíduos idosos, entre a 4ª e 9ª décadas de vida, sem predilação por sexo. O presente estudo mostra um caso de carcinoma triquilemal, recidivado, de difícil tratamento, em mesma topografia de um carcinoma basocelular tratado previamente com cirurgia e radioterapia. Palavras-chave: Neoplasias cutâneas; Neoplasias induzidas por radiação; Neoplasias de anexos e de apêndices cutâneos

Objective: To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain Rev Bras Ortop. 2011;46(4):424-30

To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain (89.2%). There was partial or complete improvement in a majority of the cases (52.2%). Out of 157 cases studied, 86.6% died. The maximum survival time was 13.6 years, the minimum was 3 days and the mean was 13.2 months. The following frequencies of Tokuhashi scores were found among the operated cases: up to 8 points, 111 cases; 9-11 points, 43 cases; and 12-15 points, three cases. The mean survival time in months for all 157 patients according to the Tokuhashi score was: 0-8 points, 15.4 months; 9-11 points, 11.4 months; and 12-15 points, 12 months. Conclusion: Unlike the nonsurgical approach recommended by Tokuhashi for patients with lower scores, this group in our study was sent for surgery, with better results than those of non-operated patients reported by Tokuhashi.

Our SLN procedure is a safe and accurate technique that increases metastatic nodal detection rates by 4.2 % after IHC. The SLN method performed better when analyzing each side; however, one FN occurred, even after applying the MSKCC algorithm.

RESUMOObjetivo: Avaliar o perfil dos pacientes com neoplasia maligna de estômago, que receberam atendimento e tratamento no Hospital Municipal Dr. Jose de Carvalho Florence (HMJCF). Métodos: Estudo retrospectivo a partir do levantamento de prontuários. Análises foram feitas com uma amostragem e proporções esperadas desiguais e Quadros de contingência. Para se verificar associação entre as variáveis, utilizado o teste Qui–Quadrado de Pearson, considerando-se p ≤ 0,05, em um grau de confiabilidade de 95%. Resultados: O sexo masculino é o com maior número de casos na proporção de 2:1. A idade média ao diagnóstico é 65,16 anos. A queixa mais comum apresentada por estes pacientes foi a epigastralgia seguido pela inapetência. A maioria dos tumores encontrava-se no antro gástrico. Cinquenta e nove destes pacientes foram submetidos a cirurgia sendo 45 com intuito curativo. A sobrevida média foi de 15 meses e a taxa de sobrevida em 5 anos de apenas 6%.  Conclusão: O CG é uma doença muito agressiva e de prognóstico ruim. Suas manifestações iniciais são inespecíficas, o que torna seu diagnóstico em fases iniciais muito difícil.Palavras chave: Câncer Gástrico, Úlcera gástrica, Perfil de SaúdeABSTRACTObjective: Evaluate the profile of patients with malignant neoplasia of stomach, receiving care and treatment in Hospital Municipal Dr. Jose de Carvalho Florence (HMJCF). Methods: Retrospective study based on a survey of medical records. Analysis were made with a sampling and unequal expected ratios and contingency tables. To assess the association between variables, will be used the chi-square test, considering p ≤ 0.05, at a reliability level of 95%. Results: The largest number of cases are male, ratio of 2:1. The average age at diagnosis is 65.16 years. Caucasians followed by mulatto were the most frequent with Gastric Cancer. The most common complaint presented by these patients was abdominal pain followed by loss of appetite. Most tumors found in the gastric antrum. Fifty-nine of these patients underwent surgery with curative intent in 45. Twenty of them had some type of metastasis intraoperatively and 12 outpatients progressed to metastatic lesions. The median survival was 15 months and the survivor rate in 5 years was only 6%. Conclusion: The Gastric Cancer is a very aggressive and poor prognosis disease. Its initial symptoms are nonspecific, making diagnosis difficult in the early stages.Keywords: Gastric Cancer, Gastric Ulcer, Health Profile.

O carcinoma de células escamosas é a neoplasia maligna mais frequente da cabeça e pescoço, e no Brasil o da cavidade bucal é o quinto mais freqüente em pacientes do sexo masculino (4,7%), e o sexto em pacientes do sexo feminino (2%), considerando todas as topografias da cabeça e pescoço 1 . A maioria dos pacientes apresenta doença avançada na primeira consulta, ou seja, tumores com está-dio clínico III ou IV em 53,4% dos casos, segundo estatísti-cas do Serviço de Registro Hospitalar de Câncer do Hospital Erasto Gaertner, em Curitiba 2 . Os tumores mais avançados necessitam frequentemente de procedimentos cirúrgicos mais complexos, com ressecção de partes moles, ossos da face e algumas vezes da pele, necessitando de fechamento com retalhos locais, regionais ou à distância, microcirúrgicos ou não. Os tipos de cirurgia empregados dependem principalmente da localização e da extensão do tumor, das condições clínicas do paciente, da prática da equipe médica e da disponibilidade técnica na instituição 3 . A reconstrução deve ser imediata, principalmente a reconstrução mandibular, sempre que possível. Diversas opções são consideradas para cada caso, como: enxerto cutâneo, retalhos de língua, miomucoso de bucinador, muscular de masseter, nasogeniano, miocutâneos (peitoral maior, peitoral menor, platisma, trapézio, grande dorsal e nasogeniano) e fasciocutâneos. Nos últimos anos, sempre que indicados e existirem condições técnicas favoráveis, tem sido usado as reconstruções microcirúrgicas (reto abdominal, crista ilíaca, fíbula, retalho de antebraço, retalho lateral do braço e grande dorsal) as quais ocupam um espaço significativo no capítulo das reconstruções 3,4 . As complicações das cirurgias para câncer da boca são inerentes ao processo do tratamento, levando-se em conta os fatores de risco próprios da doença e dos pacientes, o tipo de ressecção e reconstrução. Como exemplo, podemos citar alterações da deglutição, causando broncoaspiração e pneumonia, distúrbios respiratórios e fonatórios, atrofia do músculo trapézio e consequente queda do ombro (ressecção ou lesão do nervo espinhal), elevação da cúpula diafragmática levando a desconforto respiratório e ao risco de atelectasia pulmonar (lesão do nervo frênico), perda dos movimentos dos músculos da mímica labial e da sensibilidade dos mesmos (lesão do ramo mandibular do nervo facial), hematomas, seromas, acúmulo de linfa (lesão do ducto torácico), edema facial (distúrbio de drenagem venosa por lesão da veia jugular interna), infec-

Apresentam-se quatro pacientes com infecção pelo vírus da imunodeficiência humana em tratamento com inibidores de proteases há oito meses e três semanas em média. Ressaltam-se o acúmulo de gordura na região dorsocervical e fáscies de lua cheia, semelhante à que ocorre na síndrome de Cushing.