carcinoma basocelular com invasão orbitária

The purpose of this paper is to report a recidivate basal cell carcinoma of the eyelid with orbital invasion located in the inner canthus of the left eye. A 79 year old, male, Caucasian patient had a basal cell carcinoma removed from the left inner eyelid canthus 8 years ago and the edges of the resection were compromised by the lesion. The patient had recurrence of the lesion and orbital invasion. He was submitted to orbital exenteration and the ethmoid bone was removed too. The authors call attention to the necessity of correct diagnosis and followup to have success in the management of the patient.

Profile of cardiovascular risk factors and mortality in patients with symptomatic peripheral arterial disease

Introduction: The present study examines cardiovascular risk factor profiles and 24-month mortality in patients with symptomatic peripheral arterial disease. Design Study: Prospective observational study including 75 consecutive patients with PAD (67 ± 9.7 years of age; 52 men and 23 women) hospitalized for planned peripheral vascular reconstruction. Doppler echocardiograms were performed before surgery in 54 cases. Univariate analyses were performed using Student's t-test or Fisher's exact test. Survival analysis at 24-month follow-up was performed using the Cox regression model and Kaplan-Meier method including age and chronic use of aspirin as covariates. Survival curves were compared using the log-rank test. Results: Hypertension and smoking were the most frequent risk factors (52 cases and 51 cases, respectively), followed by diabetes (32 cases). Undertreated dyslipidemia was found in 26 cases. Fasting glycine levels (131 ± 69.1 mg/dl) were elevated in 29 cases. Myocardial hypertrophy was found in 18 out of 54 patients. Thirty-four patients had been treated with aspirin. Overall mortality over 24 months was 24% and was associated with age (HR: 0.064; CI95: 0.014-0.115; p=0.013) and lack of use of aspirin, as no deaths occurred among those using this drug (p<0.001). No association was found between cardiovascular death (11 cases) and the other risk factors. Conclusion: There is a high prevalence of uncontrolled (treated or untreated) cardiovascular risk factors in patients undergoing planned peripheral vascular reconstruction, and chronic use of aspirin is associated with reduced all-cause mortality in these patients.

Oral stomatitis induced by endogenous progesterone: Case report

Oral stomatitis induced by endogenous progesterone is a rare clinical condition which may be associated with cutaneous involvement. That is probably due to the peak of progesterone production during the luteal phase of the menstrual cycle. In the present case report, a 21-year-old patient displayed recurrent ulcerative lesions located on the buccal mucosa or the upper lip, on a monthly basis since the age of 15. Such lesions would always manifest themselves on the second day until the end of the menstrual cycle. © 2009 Informa UK Ltd All rights reserved.

Morphologic changes and the expression of alpha-melanocyte stimulating hormone and melanocortin-1 receptor in melasma lesions: A comparative study

Melasma is a common acquired symmetrical hypermelanosis characterized by irregular light- to dark-brown macules on sun-exposed skin areas. The literature shows few studies on its physiopathogeny. However, changes in α-melanocyte stimulating hormone (α-MSH) secretion and melanocortin-1 receptor (MC1-R) expression may play a role to trigger this condition. Biopsies were taken from both melasma skin and adjacent perilesional normal skin of 44 patients. The biopsies were submitted for hematoxylin and eosin and Fontana-Masson staining and immunohistochemistry with Melan-A, α-MSH, and MC1-R, and processed for transmission electron microscopy. In some cases, they were submitted to MC1-R gene expression analysis by real-time polymerase chain reaction. Increased lymphohistiocytic infiltrate and solar elastosis, higher epidermal melanin were observed in melasma skin. Electron microscopy revealed a greater number of mature melanosomes in keratinocytes and melanocytes, and more prominent cytoplasmic organelles in melasma skin. There was no difference in melanocyte number between areas. However, melanocytes were larger and more dendritic in melasma skin. Immunohistochemistry with α-MSH and MC1-R showed significant labeling in melasmic epidermis but MC1-R messenger ribonucleic acid (RNAm) did not show significant quantitative difference between melasma and normal skin. © 2010 by Lippincott Williams & Wilkins.

Avaliação comparada do uso de linguagens de indexação em catálogos de bibliotecas universitárias para recuperação por assunto

A comparative evaluation was made of the use of natural language versus two specialized indexing languages, aiming to demonstrate the influence of the availability of indexing languages on the functioning of information retrieval systems. The study was conducted within the ambit of the construction of search strategies by subject in online university library catalogs. The precision ratio was calculated to determine the accuracy of each indexing language in subjectbased information retrieval. From the comparative evaluation of the use of indexing languages, it was concluded that the term specificity required by the user during retrieval was more satisfactory when the query was made through controlled languages, whose availability and simplicity is also an indispensable requisite.

Políticas de indexação no âmbito da gestão do conhecimento organizacional

The purpose of this article is to understand, by means of the analysis of the literature, the existing relations between the indexing policies and the organizational knowledge management in organizational contexts as support to the implementation of strategic actions. It also searches for identifying the essential elements for the establishment of indexing policies and which mechanisms this process is based on. As result of some inferences, an organizational knowledge management model is presented with elements related to the individuals, the organization and the external environment as well.

Do conhecimento tácito ao conhecimento explícito: A elaboração de manual de política de indexação em bibliotecas universitárias

The indexing policy establishes the guiding principles and criteria for the indexer when determining the subjects of the documents. This article shows how to capture the indexers' tacit knowledge into explicit knowledge using the group verbal protocol methodology to produce an indexing manual. Continuing professional education results to be a key factor in obtaining good results when formalizing the indexing policy of a library and keeping it up to date.

A linguagem, o texto e o documento no contexto da ciência da informação

The relation among the concepts text, document and information is discussed, with the aim of clarifying the concept of document, with a focus in the field of economic information organization and management. A document is a medium in which information is recorded and manifested. A document is, thus, material, has a purpose, can be organized and treated for its improved dissemination, and has a specific subject and context.

Elementos de política de indexação em biblioteca universitária da área médica

In the context of university libraries, the optimization and streamlining of services and processes related to informational content indexing and retrieval are strongly influenced by the indexing policy adopted. This article is aimed at researching the indexing policy elements that are more suitable for medical university libraries. To achieve our objective, we applied three instruments: organizational culture analysis, individual verbal protocol and evaluation of indexing. Results emphasize the importance of developing an indexing policy to improve the processes and services offered by university libraries, as well as the retrieval of information by the user community. More studies are necessary in the medical area involvoving catalogers, experts, users and managers for the development of the indexing manual.

Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women

Background Melasma is a common acquired chronic hypermelanosis of sun-exposed areas which significantly impacts quality of life. There are few epidemiological studies in medical literature concerning these patients. Objective Characterize clinical and epidemiological data on Brazilian female patients with melasma. Methods A semi-structured questionnaire was administered to melasma patients treated at a dermatology clinic between 2005 and 2010. Association between variables was performed by multivariate regression models. Results We assessed 302 patients; intermediate skin phototypes III (34.4%) and IV (38.4%) were prevalent. Mean disease onset age was 27.5 ± 7.8 years and familiar occurrence of melasma was identified in 56.3%. The most commonly reported trigger factors were pregnancy (36.4%), contraceptive pills (16.2%) and intense sun exposure (27.2%). Preferred facial topographies were zygomatic (83.8%), labial superior (51.3%) and frontal (49.7%). Pregnancy induced melasma has been associated to early disease (OR = 0.86) and number of pregnancies (OR = 1.39). Childbearing was correlated to melasma extension. Older disease onset age was associated to darker skin phototypes. Co-occurrence of facial topographies supported clinical classification as centrofacial and peripheral melasma. Conclusion This population was characterized by: a high prevalence in adult females, intermediate skin phototypes, disease precipitation by hormonal stimulus and familiar genetic influence. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

Evaluation epidermal p53 immunostaining by digital image analysis

Digital techniques have been developed and validated to assess semiquantitatively immunohistochemical nuclear staining. Currently visual classification is the standard for qualitative nuclear evaluation. Analysis of pixels that represents the immunohistochemical labeling can be more sensitive, reproducible and objective than visual grading. This study compared two semiquantitative techniques of digital image analysis with three techniques of visual analysis imaging to estimate the p53 nuclear immunostaining. Methods: Sixty-three sun-exposed forearm-skin biopsies were photographed and submitted to three visual analyses of images: the qualitative visual evaluation method (0 to 4 +), the percentage of labeled nuclei and HSCORE. Digital image analysis was performed using ImageJ 1.45p; the density of nuclei was scored per ephitelial area (DensNU) and the pixel density was established in marked suprabasal epithelium (DensPSB). Results: Statistical significance was found in: the agreement and correlation among the visual estimates of evaluators, correlation among the median visual score of the evaluators, the HSCORE and the percentage of marked nuclei with the DensNU and DensPSB estimates. DensNU was strongly correlated to the percentage of p53-marked nuclei in the epidermis, and DensPSB with the HSCORE. Conclusion: The parameters presented herein can be applied in routine analysis of immunohistochemical nuclear staining of epidermis. © 2012 John Wiley & Sons A/S.

Histoplasmose cutânea reveladora de infecção pelo HIV

Histoplasmosis is a systemic mycosis endemic in extensive areas of the Americas. The authors report on an urban adult male patient with uncommon oral-cutaneous lesions proven to be histoplasmosis. Additional investigation revealed unnoticed HIV infection with CD4+ cell count of 7/mm3. The treatment was performed with amphotericin B, a 2065 mg total dose followed by itraconazole 200mg/daily plus antiretroviral therapy with apparent cure. Histoplasmosis is an AIDS-defining opportunistic disease process; therefore, its clinical diagnosis must drive full laboratory investigation looking for unnoted HIV-infection. © 2013 by Anais Brasileiros de Dermatologia.

Crescimento inicial e nutrição de cedro (Cedrela fissilis Vell.) em função de doses de nitrogênio

We aimed to evaluate the effects of nitrogen rates in early growth, SPAD index, content and accumulation of nutrients in cedar seedlings. The experiment was carried out in a plastic greenhouse and the seedlings were grown in plastic pots filled with 20 dm-3of Rhodic Hapludox, arranged inrandomized blocks with four replications. Rates of 0, 40, 80, 120 and 160 mg dm-3N were tested. Fertilization up to 160 mg dm-3N promoted increases in SPAD index and early growth of plants, beyond greater absorption of N,P, K, Ca, Mg, S, B, Cu, Fe, Mn and Zn. Overall, lower N rates limited growth but not the absorption of nutrients by cedar plants. In leaves, the only nutrien taffected was the B which their content was reduced with increasing of N rate. Increased of nitrogen fertilization changed the Cu distributionin plants, since increased Cu content in roots and reduced their content in stem. Higher N rates promoted higher accumulation of all nutrients due to the increase of dry matter. Nitrogen fertilization changed the dynamic of nutrient absorption in cedar. With 160 mg dm-3N, the amount absorbed followed the order: N>S>Ca>K>Mg>P>Fe>Mn>B> Zn> Cu.