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Objective: To analyze the clinical outcome of patients after pelvic exenteration for advanced primary or recurrent vaginal cancer. Design: Retrospective cohort study. Materials and Methods: We anal...

Vesicovaginal fistulas are devastating conditions for the affected women. The combination of a hysterectomy and radiation increases the fistula risk 5-10 times. Radiation-induced recurrent vesicovaginal fistulas have the lowest success rate and require the most demanding treatment. We present the case of a recurrent post-radiation vesicovaginal fistula treated with a small intestine graft after unsuccessful conservative and failed previous operative treatments. The surgical management with a small intestine graft led to a permanently closed fistula. We describe the surgical abdominal procedure step-wise and review the rather scarce, post-radiation fistula literature. The closure of a vesicovaginal fistula with a small intestine graft is a complex surgical treatment with a long-term, successful result.

Background Uterine Tumors Resembling Ovarian Sex Cord Tumors (UTROSCT) are rare tumors of low malignancy. In the past, these tumors were mainly treated by hysterectomy. More recently, some authors have proposed conservative surgical management for women wishing to preserve fertility. This article is the first to report on organ-preserving treatment in the case of recurrence or disease persistence. Cases We report on three patients with UTROSCT, two of them young, not having completed family planning. One even gave birth to a healthy child after fertility-preserving treatment of a persistent UTROSCT. To our knowledge, this is the first pregnancy reported after surgical treatment of a persistent UTROSCT so far. Conclusion A fertility-sparing approach should always be considered in young women with UTROSCT who wish to preserve their fertility, also in cases of recurrence or disease persistence., Highlights • First report on organ-preserving treatment in case of UTROSCT recurrence • First pregnancy reported after surgical treatment of a persistent UTROSCT • Fertility-preserving approach also in cases of recurrence or disease persistence

ObjectiveThe aim of this study was to analyze the clinical experience and outcome of patients who have undergone pelvic exenteration for primary advanced or recurrent endometrial cancer.MethodsWe analyzed the medical records of 40 women who underwent pelvic exenteration to treat primary advanced or recurrent endometrial cancer.ResultsPelvic exenteration was performed in 40 patients with primary advanced or recurrent endometrial cancer. Three patients (8%) underwent a primary exenteration, and 37 patients (92%) underwent a secondary exenteration. A total exenteration, anterior exenteration, and posterior exenteration was performed in 85%, 5%, and 10% of patients, respectively.In 31 cases, exenteration was performed with a curative aim, and in 9 cases, exenteration was performed with a palliative aim. The overall survival rates were 61.4% at 5 years and 51.1% at 10 years. For the 31 patients who underwent pelvic exenteration with a curative aim, the overall survival rates were higher than those for the entire study population and were 72.6% at 5 years and 59.4% at 10 years. For the 9 patients who underwent a palliative exenteration, the overall survival rates were 19.1% at 5 years and 0% at 10 years. This is to the best of our knowledge the biggest study of pelvic exenteration in patients with endometrial cancer.ConclusionsOur data show that pelvic exenterations are a valid therapeutic option with long-term survival in select patients.

Pelvic exenteration has been performed since 1946 and is considered as a treatment option for select patients with advanced gynecologic malignancies.

OBJETIVO: Este estudo procurou avaliar o conteúdo de gordura dos portadores do HIV segundo o tempo de uso da terapia antirretroviral (TEMPARV), < 1 ano e > 1 ano. MÉTODOS: A regressão linear múltipla foi utilizada para investigar a associação entre as variáveis ultrassonográficas dos compartimentos corporais de gordura (CCG) da face, braço, abdômen subcutâneo e visceral e as seguintes variáveis explanatórias: sexo, idade, IMC e TEMPARV. RESULTADOS: Do total de pacientes (187), 102 com TEMPARV > 1ano eram portadores de lipodistrofia relacionada ao HIV (LD-HIV), diagnosticados de acordo com os questionários clínicos. Já aqueles com TEMPARV < 1 ano (n= 85, ≈46%) não apresentavam LD-HIV. Com relação ao compartimento visceral, a diferença entre os pacientes com TEMPARV > 1 ano e < 1 ano foi de 11 mm de gordura adicionais naqueles em TEMPARV > 1 ano. As mulheres tinham mais gordura que os homens em todos os CCG periféricos, enquanto eles tinham 7,2 mm a mais de gordura visceral que elas, em média. CONCLUSÃO: A ultrassonografia é um método capaz de medir a espessura de gordura dos CGC aplicável à prática clínica para diagnosticar a LD-HIV.OBJECTIVE: This study aimed to evaluate the body fat content of HIV patients according to the duration of antiretroviral therapy use (DURARV), < 1 year and > 1 year. METHODS: Multiple linear regression was used to investigate the association between ultrasonographic variables of body fat compartments (BFCs) of the face, arm, subcutaneous and visceral abdomen, and the following explanatory variables: gender, age, BMI, and DURARV. RESULTS: Of all patients (187), 102 of them with DURARV > 1 year were suffering from HIV-related lipodystrophy (HIV-LD), diagnosed through clinical questionnaires. Those with DURARV < 1 year (n = 85, = 46%) did not have HIV-LD. Regarding the visceral compartment, the difference between those with DURARV > 1 year and < 1 year was 11 mm of additional fat content in those with DURARV > 1 year. Women had more fat than men in all peripheral BFCs, while men had 7.2 mm more visceral fat than women, on average. CONCLUSION: Ultrasonography is a method capable of measuring the thickness of BFCs and is applicable to clinical practice to diagnose HIV-LD.

SummaryObjectiveThis study aimed to evaluate the body fat content of HIV patients according to the duration of antiretroviral therapy use (DURARV), < 1 year and ≥ 1 year.MethodsMultiple linear regression was used to investigate the association between ultrasonographic variables of body fat compartments (BFCs) of the face, arm, subcutaneous and visceral abdomen, and the following explanatory variables: gender, age, BMI, and DURARV.ResultsOf all patients (187), 102 of them with DURARV ≥ 1 year were suffering from HIV-related lipodystrophy (HIV-LD), diagnosed through clinical questionnaires. Those with DURARV < 1 year (n=85, ≈ 46%) did not have HIV-LD. Regarding the visceral compartment, the difference between those with DURARV ≥ 1 year and < 1 year was 11mm of additional fat content in those with DURARV ≥ 1 year. Women had more fat than men in all peripheral BFCs, while men had 7.2mm more visceral fat than women, on average.ConclusionUltrasonography is a method capable of measuring the thickness of BFCs and is applicable to clinical practice to diagnose HIV-LD.

Objective The aim of this study was to summarize the clinical experience at our clinic with pelvic exenteration as a treatment for cervical cancer with special regard to the indications and outcomes of specific patient groups. Methods Medical records of 282 women who underwent pelvic exenteration to treat cervical cancer were analyzed. Results In total, 70 patients (25%) underwent primary exenteration, and 212 (75%) underwent secondary exenteration. Exenteration was anterior for 14 (5%) patients, posterior for 6 (2%) and total for 262 (93%). The overall survival (OS) of the 282 patients was 41% at 5years and 37% at 10years. The disease-free survival at 5years was 61%. For 133 patients for whom pelvic exenteration was a curative procedure, the OS was 64% at 5years and 57% at 10years. For cases of pelvic exenteration as a palliative intervention, the OS was 19% at 5years and 18% at 10years. No difference was seen in the OS at 5years between patients who received primary and secondary operations. No significant difference in the OS was found regardless of whether the patients had positive pelvic lymph nodes, whereas in cases of paraaortic lymph node metastasis, the OS was significantly lower. Out of all of the procedures, 139 (49%) involved no perioperative or postoperative complications. One major complication was reported for 72 (26%) patients, two complications occurred for 42 patients (15%) and more than three complications were noted for 29 (10%) patients. Conclusion Pelvic exenteration is an effective technique with a high percentage of long-term survivors. To the best of our knowledge, our study involves the largest published number of patients treated with pelvic exenteration for a single gynecological cancer and shows that previous contraindications for pelvic exenteration, such as lymph node metastasis (especially when confined to the pelvic lymph nodes), older age or palliative intent, should be reconsidered.

The study evaluated the use of sonographic measurements as an alternative to assessments based on clinical or other imaging techniques for the diagnosis of body-fat abnormalities. The study enrolled 179 HIV-infected patients, 81 (45.3%) of them diagnosed as lipodystrophy (LD)-positive based on a clinical standard questionnaire. Association between clinical LD and sonographic measurements of face, right upper limb, subcutaneous abdomen, and visceral compartments was evaluated by multiple logistic regression. The predicted probability of the logistic model was 0.64, corresponding to a maximum sensitivity of 69.1% (58%-79%), a specificity of 94.9% (88%-98%), and to positive and negative predictive values of 92% (82%-97%) and 79% (70%-86%), respectively. Kappa measure of concordance was 65% (54%-77%). Low sensitivity poses a problem for the use of sonography to detect LD in the clinical routine as a single exam, speaking in favor of the combined use of clinical and sonographic measurements over time.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia Ambiental. Este trabalho tem por objetivo determinar a situação em que se encontra o balneário de Canasvieiras, em Florianópolis (SC), quanto ao processo de ocupação e urbanização. Para tanto, descreve a evolução histórica do mesmo, com relatos de como vivia a comunidade, da ocupação da região, e, posteriormente, de como foi descoberta pelos turistas. Analisa ainda a evolução do crescimento populacional e territorial do balneário, apontando os principais fatores que influenciaram para o seu crescimento populacional; estima o número de turistas, moradores e trabalhadores; identifica as implicações do comércio local na praia; determina a capacidade de carga; e apresenta um estudo comparativo do fluxo turístico nas temporadas de 2001 e 2003. Por fim, determina o estágio do ciclo de vida do balneário, buscando dados capazes de apontar o destino que está sendo imposto à localidade. Utilizou se a pesquisa exploratória descritiva, com abordagem quantitativa, adequada às características dos dados disponíveis. Na coleta de dados primários, utilizou-se a técnica de observação direta, durante os meses janeiro e fevereiro das temporadas 2001 e 2003. Os dados secundários têm por base uma pesquisa documental em bancos de dados de órgãos públicos, entre junho de 2000 e abril de 2004. Como resultado, verifica-se que o estágio do desenvolvimento em que se encontra o balneário é crítico, pois se verificou a sobrecarga na natureza, necessitando de um planejamento com ações pontuais que propiciem uma revitalização da região, tais como a ampliação da rede de esgoto sanitário em Canasvieiras e a complementação da rede em Cachoeira do Bom Jesus e Ponta das Canas; além disso, necessita de um plano diretor adaptado à região, o alargamento da praia, bem como a aprovação e implementação da Lei de Gerenciamento Costeiro (SDM).

A new test-the Hotis-antibiogram permitted in a short time, just two days a good and cheap indication for the choice of a more suitable treatment for bovine mastitis. Milk samples from 282 infected were submitted to the Hotis test and the results allowed their distribuition into 11 groups. A pool represented by an aliquot from each sample of a group was then submitted to the antibiogram. Thus this new test wealed itself as an useful and rapid test once just 11 antibiograms has be performed.