Necrotizing soft tissue infection of the breast: Case report and literature review

Background: Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement. Methods: We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases. Case Report: On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa. Conclusion: Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition. © 2012, Mary Ann Liebert, Inc.

Fine needle aspirate cell blocks are reliable for detection of hormone receptors and HER-2 by immunohistochemistry in breast carcinoma

Aims: To evaluate the reliability of fine needle aspirate cell blocks in the assessment of oestrogen receptor (ER), progesterone receptor (PR) and HER-2/neu proteins by immunohistochemistry in comparison with surgical specimens. Materials and methods: This is a retrospective study of 62 cases of breast carcinoma diagnosed by fine needle aspiration cytology (FNAC) and confirmed using the surgical specimen. Immunohistochemical tests were performed to assess the presence of oestrogen receptor (ER), progesterone receptor (PR) and HER-2/neu proteins in cell blocks and the corresponding surgical specimens. The cell block method used alcohol prior to formalin fixation. Cases with 10% or more stained cells were considered positive for ER and PR. Positivity for HER-2/neu was assessed on a scale of 0-3+. The criterion for positivity was a score of 3+. Results: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the cell blocks in the investigation of ER, PR and HER-2/neu protein (3+) were (%): ER, 92.7, 85.7, 92.7, 85.7 and 90.3; PR, 92.7, 94.7, 97.4, 87.0 and 93.5; HER-2/neu, 70.0, 100.0, 100.0, 94.5 and 95.2. Discrepancies were seen in cell blocks in the 1+ and 2+ HER-2/neu staining scores: two of 12 cases scoring 2+ and one case of 26 scoring 1+ on cell blocks scored 3+ on surgical specimens. The correlation index between cell block and corresponding surgical specimen varied from 90% to 94%. Conclusion: Cell blocks provide a useful method of assessing ER, PR and HER-2/neu, mainly for inoperable and recurrent cases, but consideration should be given to carrying out FISH analysis on 1+ as well as 2+ HER-2/neu results. © 2012 Blackwell Publishing Ltd.

Multi-choice mixed integer goal programming optimization for real problems in a sugar and ethanol milling company

Goal Programming (GP) is an important analytical approach devised to solve many realworld problems. The first GP model is known as Weighted Goal Programming (WGP). However, Multi-Choice Aspirations Level (MCAL) problems cannot be solved by current GP techniques. In this paper, we propose a Multi-Choice Mixed Integer Goal Programming model (MCMI-GP) for the aggregate production planning of a Brazilian sugar and ethanol milling company. The MC-MIGP model was based on traditional selection and process methods for the design of lots, representing the production system of sugar, alcohol, molasses and derivatives. The research covers decisions on the agricultural and cutting stages, sugarcane loading and transportation by suppliers and, especially, energy cogeneration decisions; that is, the choice of production process, including storage stages and distribution. The MCMIGP allows decision-makers to set multiple aspiration levels for their problems in which the more/higher, the better and the less/lower, the better in the aspiration levels are addressed. An application of the proposed model for real problems in a Brazilian sugar and ethanol mill was conducted; producing interesting results that are herein reported and commented upon. Also, it was made a comparison between MCMI GP and WGP models using these real cases. © 2013 Elsevier Inc.

Nodular dermatofibrosis in a gentian shepherd dog: case report

An 7-year-old male German shepherd dog not neutered was attended presenting several cutaneous nodules ranging from 0.5-3 cm in diameter at least a one year history, located mainly in thoracic and pelvic limbs, with progressive weight loss over two months. Fine needle aspiration biopsy and pelvic and thoracic limbs nodules excision biopsy were performed. After histopathological diagnosis, nodular dermatofibrosis diagnosis was determined and abdominal ultrasound was performed for possible renal cysts evaluation. The animal received treatment to control secondary bacterial infection. It is necessary to carry out histopathological examination and ultraosund to identify possible renal cysts and for definitive diagnosis. There is no specific treatment for nodular dermatofibrosis. © 2013 Asian Network for Scientific Information.

Programação, conexão e avaliação de psicrômetro aspirado de termopar de baixo custo em micrologger para estudos agrometeorológicos

As the psychrometric method is considered standard for the measurement of relative humidity, many studies have used aspirated thermocouple psychrometers connected to microloggers but, however, they do not detail how the aspiration of the air stream is done. However, one of the major difficulties of aspirated thermocouple psychrometers is to program and to connect it in micrologger, because specific programming and connection are requires, and still some skills in getting accurate measurements. This work aimed to provide the programming and the connection of the aspirated thermocouple psychrometer type T for the CR10X microloggers and CR23X of Campbell Scientific, evaluating the quality of measurements of temperature and air relative humidity in relation the a sensor Vaisala HMP50. The non-continuous measurements were made in the period 2006/09/04 to 2007/07/11 at Jaboticabal, SP. The air temperature measurements were similar between the Vaisala sensors and aspirated thermocouple psychrometer, but the relative humidity measurements were significantly different. The measurements obtained by the aspirated thermocouple psychrometer connected to CR10X micrologger were the most accurate. Using the programming and connection of a micro-fan to suck in the dry and moist bulbs of aspirated thermocouple psychrometer in microloggers models CR10X and CR23X, it is possible to obtain measurements of air temperature with good precision and accuracy, and measurements of air relative humidity with good precision, but accuracy is not always attainable due to the difficulties inherent to the physical processes that occur in the wet bulb, the skill in the use and maintenance of this equipment and the reservoir protection against radiative effects.

Systemic CA-MRSA infection following trauma during soccer match in inner Brazil: Clinical and molecular characterization

Even though community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was described a decade ago, reports from Brazil are scarce and cases occurred in large urban centers. We report MRSA sepsis in a 16-year-old male from a small town and who had no history of exposure to healthcare or recent travel. After trauma during a soccer match, he presented swelling in the right thigh, which evolved in a month to cellulitis complicated by local abscess, orchitis and pneumonia. The patient presented severe sepsis, with fever and respiratory failure. Laboratory findings included blood leukocyte counts above 40,000/mm3 and thrombocytopenia. He was submitted to mechanical ventilation and therapy with vancomycin and imipenem. He had a slow but favorable response to therapy and was discharged after six weeks of hospitalization. MRSA grew from blood cultures and respiratory aspirates obtained before antimicrobial therapy. The isolate belonged to sequence type 5, spa type t311, harbored SCCmec type IV and genes for Panton-Valentine leukocidin and Enterotoxin A. The pulsed-field gel electrophoresis pattern was distinct from North American classic CA-MRSA clones. However, the sequence type and the spa type revealed that the clone belong to the same clonal complex isolated in Argentina. This is the first CA-MRSA infection reported in that region, with significant epidemiologic and clinical implications. © 2013 Elsevier Inc.

Facial hemangiossarcoma in a blue-fronted amazon parrot (Amazona aestiva)

Here we describe the first case report of an hemangiosarcoma in a male Blue-fronted amazon parrot (Amazona aestiva). The mass was localized near the inferior portion of the right orbit. A fine needle aspiration biopsy (FNAB) was performed and a presuntive diagnosis of hemangioma/hemangiosarcoma was established. Further histopathological evaluation revealed a mesenchymal neoplasm composed basically by well formed vascular channels lined by pleomorphic endothelial cells. Thus, the final diagnosis was a well-differentiated cutaneous hemangiosarcoma.

Retrospective study on the cytological exams in a veterinary technic hospital in a five year period

The cytological exam is a practical diagnostic aplication which allows the detection of inflammatory, proliferative and infectious disturbances. In the present study, the results of cytological exams during six years were evaluated, determining the most common type of disorder (inflammatory, infectious, proliferative). Epidemiological aspects such as species, breed, sex and age were taken into account. 270 reviews were evaluated and the prevalence was neoplasms (53%). The canine specie was the most observed, with 92% of cases. Females totaled 53%. The age ranged from one to 17 years and the interval of six to 10 years was most observed (40% of cases). The round cell neoplasms were the most prevalent, followed by breast neoformations.

Caracterização e classificação da deglutição orofaríngea do idoso institucionalizado: avaliaçao clínica fonoaudiológica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Diagnóstico comparativo entre a histopatologia e citologia por capilaridade com agulha de insulina nas neoplasias mamárias caninas

Pós-graduação em Cirurgia Veterinária - FCAV

Fístula oronasal em cão: reparo com flape simples associado a fator proteíco angiogênico purificado do látex de seringueira, veiculado com matriz de esponja de colágeno : estudo experimental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aspiração folicular videolaparoscópica em ovinos: avaliação ovariana macro e microscópica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo clínico-citológico em ovinos sadios e portadores de afecções pulmonares de ocorrência natural, utilizando-se o lavado traqueobrônquico como auxílio diagnóstico

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Ocorrência de Leishmania sp. em gatos do município de Araçatuba - São Paulo - Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Inoculação de células-tronco mesenquimais autólogas e alogênicas, provenientes da medula óssea, em tecido muscular de equinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)