Intraductal Carcinoma Of The Prostate: Interobserver Reproducibility Survey Of 39 Urologic Pathologists.

The diagnosis of intraductal carcinoma (IDC) of the prostate remains subjective because 3 sets of diagnostic criteria are in use. An internet survey was compiled from 38 photomicrographs showing duct proliferations: 14 signed out as high-grade prostatic intraepithelial neoplasia (HGPIN), 17 IDC, and 7 invasive cribriform/ductal carcinoma. Each image was assessed for the presence of 9 histologic criteria ascribed to IDC. Thirty-nine respondents were asked to rate images as (1) benign/reactive, (2) HGPIN, (3) borderline between HGPIN and IDC, (4) IDC, or (5) invasive cribriform/ductal carcinoma. Intraclass correlation coefficient was 0.68. There was 70% overall agreement with HGPIN, 43% with IDC, and 73% with invasive carcinoma (P < .001, χ(2)). Respondents considered 19 (50%) of 38 cases as IDC candidates, of which 5 (26%) had a two-thirds consensus for IDC; two-thirds consensus for either borderline or IDC was reached in 9 (47%). Two-thirds consensus other than IDC was reached in the remaining 19 of 38 cases, with 15 supporting HGPIN and 4 supporting invasive carcinoma. Findings that differed across diagnostic categories were lumen-spanning neoplastic cells (P < .001), 2× benign duct diameters (P < .001), duct space contours (round, irregular, and branched) (P < .001), papillary growth (P = .048), dense cribriform or solid growth (both P = .023), and comedonecrosis (P = .015). When the 19 of 38 images that attained consensus for HGPIN or invasive carcinoma were removed from consideration, lack of IDC consensus was most often attributable to only loose cribriform growth (5/19), central nuclear maturation (5/19), or comedonecrosis (3/19). Of the 9 histologic criteria, only 1 retained significant correlation with a consensus diagnosis of IDC: the presence of solid areas (P = .038). One case that attained IDC consensus had less than 2× duct enlargement yet still had severe nuclear atypia and nucleomegaly. Six fold nuclear enlargement was not significant (P = .083), although no image had both 6× nuclei and papillary or loose cribriform growth: a combination postulated as sufficient criteria for IDC. Finally, 20.5% of respondents agreed that an isolated diagnosis of IDC on needle biopsy warrants definitive therapy, 20.5% disagreed, and 59.0% considered the decision to depend upon clinicopathologic variables. Although IDC diagnosis remains challenging, we propose these criteria: a lumen-spanning proliferation of neoplastic cells in preexisting ducts with a dense cribriform or partial solid growth pattern. Solid growth, in any part of the duct space, emerges as the most reproducible finding to rule in a diagnosis of IDC. Comedonecrosis is a rarer finding, but in most cases, it should rule in IDC. Duct space enlargement to greater than 2× the diameter of the largest, adjacent benign spaces is usually present in IDC, although there may be rare exceptions.

Fibrodysplasia ossificans progressiva: case report

Fibrodysplasia ossificans progressiva is a rare genetic disease characterized by widespread soft tissue ossification and congenital stigmata of the extremities. We report on a male child followed for ten years since the age of 3 years and 9 months, when the diagnosis was made. He was born with bilateral hypoplasic hallux valgus and ventricular septal defect, corrected by transsternal approach when 32 months old. Restriction of neck mobility followed and foci of ectopic ossification appeared. Four crises of disease exacerbation were treated with oral prednisone and/or other antiinflammatory drugs. Sodium etidronate 5 to 10 mg/kg/day was prescribed intermittently during about six years but was discontinued due to osteopenia. The disease course has been relentless, with severe movement restriction including the chest wall. A review showed few similar case reports in the Brazilian literature. We revisit the criteria for diagnosis and the essentials of management and treatment.

Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis

OBJECTIVES: Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS) for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis. METHODS: Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases) underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. RESULTS: Twenty-seven patients (75%) had microlithiasis confirmed by histology and nine did not (25%). EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval) were 92.6% (74.2-98.7%), 55.6% (22.7-84.7%), 86.2% (67.4-95.5%) and 71.4% (30.3-94.9%), respectively. Overall EUS accuracy was 83.2%. CONCLUSIONS: EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.

Can Mobile Units Improve the Strategies for Cervical Cancer Prevention?

Cervical cancer is a serious public health problem in women in developing countries because of absence or ineffectiveness of screening programs. Several biases to access medical care and inequity of public health system in a continental country like Brazil limit the implementation of adequate programs to appropriately prevent the cervical cancer. Therefore, the aim of this study was to evaluate the results of applying the mobile unit (MU) for cervical cancer screening. From May 2003 to May 2004, a cervical cancer screening was offered to women aged 20-69 years, residing in 19 municipal districts of the Barretos county region, in Sao Paulo. Out of the 9,560 examination available, 2,964 (31%) women underwent screening. The medium distance traveled by the MU was 45 km. The medium time spent by women in the MU for completion of the questionnaire and doing the exam was 20 minutes. It was observed that 17.0% of women screened had never had the test or had not had it repeated within the last 3 years. The negative response was more common among women aged 20 to 29 years and 60 to 69 years and among women with less schooling and lower socio-economic income (P < 0.05). MU can significantly overcome the chronic deficiency of public health system accessibility offering opportunity to these women to participate in screening programs. Diagn. Cytopathol. 2010;38:727-730. (C) 2009 Wiley-Liss, Inc.

Simultaneous Chlamydia trachomatis and HPV Infection in Pregnant Women

Pregnancy is associated with HPV infection and with Chlamydia trachomatis (CT) infection mostly due to the natural immunosuppression. In addition, pregnancy associated to CT infection can lead to adverse conditions to the woman and fetus, and CT is also believed to be a co-factor in human immunodeficiency virus infection and HPV-induced cervical cancer. The aim of this study was to establish the odds ratios (OR) of CT infection in to HPV-infected pregnant women and vice versa of women stratified by age (<25 years) and marital status. This work is part of a national multicentric transversal study carried out in six Brazilian cities supported by the Ministry of Health of Federal Government of Brazil in 2003. Cervical scrapes of 371 pregnant women were sampled. We performed a hybrid capture-2 technique to diagnose these samples on HPV and CT infection, and the women responded a questionnaire. Significant association was observed between nonstable marital status and hr-HPV infection [OR = 2.61 (1.38-4.97) P = 0.003)], and age <25 years old [OR = 2.26 (1.09-4.71) P = 0.029]. Nonstable marital status was also associated with lr-HPV infection [OR = 2.67 (1.59-4.50) P < 0.001), and age <25 years old [OR = 2.55 (1.51-4.32) P < 0.001). Fifty of the 371 pregnant women were infected with hr-HPV (13.5%) and 111 (30.0%) were infected with lr-HPV. The coinfections of HPV and CT were found in 31 women, that is, 8.36% of the pregnant women (P < 0.001). The high rate of simultaneous CT and HPV infection in pregnant women favors the recommendation to screen pregnant women for both CT and HPV. Diagn. Cytopathol. 2010;38:397-401. (C) 2009 Wiley-Liss, Inc.

Simula????o de reuni??o com dirigente: prepara????o de informa????es e an??lise sobre programa governamental

A simula????o visa preparar gerentes e assessores para organizarem informa????es e diagn??sticos para tomada de decis??o. Apresenta diversos pontos de vista sobre um programa em andamento e estimula debates entre gestores e atores das ??reas envolvidas. A partir da aprecia????o dos pontos de vista desses atores, os participantes dever??o se preparar, em curto espa??o de tempo, para uma reuni??o com o dirigente rec??m-empossado respons??vel pelo programa em quest??o

Sistema Nacional de Gest??o do Conhecimento em Seguran??a P??blica

Visando subsidiar o processo de gest??o do Sistema ??nico de Seguran??a P??blica, a Secretaria Nacional de Seguran??a P??blica (Senasp) investe esfor??os, desde 2003, na cria????o de sistemas nacionais de coleta de dados, na moderniza????o da infraestrutura de TI e na qualifica????o dos profissionais para a produ????o desses dados e o desenvolvimento de insumos, a fim de auxiliar na distribui????o de recursos do Fundo Nacional de Seguran??a P??blica. Todas essas iniciativas comp??em o Sistema Nacional de Gest??o do Conhecimento em Seguran??a P??blica. Em parceria com profissionais e pesquisadores da ??rea e gestores de outros ??rg??os p??blicos, foi estruturada uma nova forma de fazer seguran??a p??blica. As a????es come??aram a ser baseadas em diagn??sticos; a distribui????o de recursos passou a obedecer um sistema de incentivos calcado em indicadores estat??sticos, fundamentais na constru????o do conhecimento necess??rio para aprimorar a efici??ncia, a efic??cia e a efetividade das pol??ticas de seguran??a. Paralelamente, procurou-se difundir a cultura da transpar??ncia e divulga????o de estat??sticas criminais

Avalia????o de desempenho: como avaliar os servidores de forma justa?

Na Ag??ncia Nacional de Melhorias, ??rg??o p??blico federal, os servidores t??cnico-administrativos recebem a Gratifica????o de Compensa????o do Vencimento (GCV), a qual ?? paga conforme o desempenho dos servidores, aferido anualmente. Entretanto, o processo de avalia????o de desempenho ocorre de forma injusta e com muitas disfun????es. O desempenho dos servidores n??o ?? efetivamente avaliado, como no caso da equipe do Cl??udio, que possui um servidor com desempenho aqu??m dos demais servidores, mas que recebe a mesma pontua????o

Dimensional X: a dificuldade na obten????o da informa????o em meio a problemas na gest??o de pessoas

Ant??nio foi convidado para assumir um cargo em que deveria gerenciar os sistemas de informa????o de um grande minist??rio. Com a miss??o inicial de fornecer uma informa????o sobre a for??a de trabalho, percebeu que havia problemas que iam muito al??m da simples utiliza????o desses sistemas, como a pol??tica de capacita????o de pessoal, a rotatividade de servidores, a falta de integra????o entre as ??reas e outros problemas na ??rea de gest??o de pessoas

Coopera????o Horizontal em Terra Linda: mito ou aposta?

Nas ??ltimas d??cadas o protagonismo do Brasil na arena pol??tica internacional tem se tornado mais evidente. O Pa??s tem atuado no sentido de promover a coopera????o para o desenvolvimento de v??rios pa??ses com problemas bastante complexos, buscando por meio de a????es de longo prazo alterar estruturas sociais e econ??micas. O estudo de caso apresenta o sum??rio de um diagn??stico realizado por um consultor contratado pelo governo fict??cio de Terra Linda, a fim de auxiliar a elabora????o de projeto de coopera????o horizontal a ser desenvolvido com Brasil. Embora se trate de um pa??s imagin??rio, o Estudo de Caso ?? baseado em dados reais e visa estimular o debate sobre qual o melhor modo de gerir uma parceria entre Estados-na????es, quais as ??reas priorit??rias a serem atendidas, qual a melhor forma de utilizar os recursos, bem como qual o papel de cada ator envolvido

Sistema georreferenciado de monitoramento e apoio ?? decis??o da Presid??ncia da Rep??blica (Geo/PR)

Trata-se de um sistema desenvolvido para integrar informa????es em base georreferenciada e textual de diversos ??rg??os p??blicos, a fim de possibilitar an??lises gerenciais, a atua????o estrat??gica e a decis??o ministerial sobre a concess??o de ato de assentimento pr??vio, de acordo com a Lei no 6.634/79. Ao possibilitar o cruzamento de informa????es de diversos bancos de dados, em raz??o da especialidade do Gabinete de Seguran??a Institucional da Presid??ncia da Rep??blica (GSI/PR), o sistema oportuniza o diagn??stico de incongru??ncias e conflitos de atividades entre ??rg??os da Administra????o P??blica Federal indireta e o indicativo da situa????o fundi??ria do Pa??s, tanto no aspecto territorial quanto no da riqueza mineral e respectivos interessados em sua explora????o. O sistema permite que os bancos ???conversem entre si???, o que o torna um marco na hist??ria da gest??o p??blica federal, por possibilitar o conhecimento do nosso territ??rio em tempo real, com informa????es confi??veis, precisas e amig??veis geradas em banco de dados textuais associados a uma base cartogr??fica digital composta por mapas digitalizados, fotografias a??reas e imagens de sat??lites

Integra????o das decis??es e procedimentos dos sistemas produtivo e de gest??o

O Lacen, desde sua cria????o em 1982, acompanha de forma compartilhada os esfor??os da Eletronorte em se tornar uma empresa de excel??ncia mundial. Desta forma mant??m uma cronologia de projetos e programas de trabalhos que objetivam aperfei??oar seus sistemas produtivos e de gest??o. Ap??s implantar em 1997 a gest??o por processos alicer??ada num Sistema da Qualidade - SQ baseados na norma ISO 17025, observou-se que o sistema de trabalho da unidade carecia de integra????o ?? medida que as avalia????es e diagn??sticos se efetuavam. Desta forma, a iniciativa consiste em um s??rie de a????es que visam a integra????o do sistema de trabalho, de forma a otimizar os recursos produtivos e de gest??o

Gest??o estrat??gica da Conab: avan??os e oportunidades de melhorias

Este estudo tem como objetivo realizar diagn??stico sobre o processo de gest??o da estrat??gia da Conab para identificar a integra????o do planejamento estrat??gico ?? sua execu????o operacional. Foi feita uma releitura da gest??o estrat??gica, passando pelos principais conceitos de planejamento estrat??gico at?? a descri????o do Sistema Gerencial, para a vincula????o da Estrat??gia ?? Opera????o em seus seis est??gios. Por meio de pesquisa explorat??ria e aplica????o de instrumento de coleta de dados junto aos gestores das ??reas fim e estrat??gica da Conab (Abastecimento e Pol??tica Agr??cola) foram obtidos resultados que apontaram a Companhia com um grau m??dio tr??s em maturidade estrat??gica, numa escala de zero a cinco. Diante deste resultado foi poss??vel considerar que, mesmo j?? dispondo de um planejamento estrat??gico com meios para operacionaliz??-lo, uma ??rea espec??fica e um mapa estrat??gico estabelecido, ainda h?? aus??ncia de sintonia dos seus gestores e colaboradores o que, de certa forma, acaba influenciando desfavoravelmente o processo de gest??o estrat??gica da empresa

O servi??o de an??lises cl??nicas em sintonia com o meio ambiente

As atividades humanas s??o inerentemente poluidoras. Os servi??os de diagn??stico t??m alcan??ado altos n??veis de evolu????o tecnol??gica, mas os cuidados com os res??duos gerados n??o tiveram o mesmo ritmo de crescimento. O Servi??o de An??lises Cl??nicas do Hospital de Cl??nicas da Universidade Federal do Paran?? (UFPR), preocupado com esse panorama, iniciou um projeto para valoriza????o do meio ambiente, contemplando a segrega????o de res??duos, que foram classificados de acordo com as normas vigentes em 2002 (resolu????es Conama 05/93 e 283/01). A principal etapa do projeto foi o treinamento dos funcion??rios, a padroniza????o de lixeiras, a avalia????o dos res??duos, a forma????o de um grupo de teatro e a apresenta????o da pe??a ???Lixo pro lixo???. Com o adequado gerenciamento dos res??duos, houve redu????o de envio ?? coleta hospitalar e incalcul??veis ganhos ambientais

Qualidade de vida no trabalho: a perspectiva dos servidores e colaboradores de uma institui????o p??blica do poder executivo federal

O presente trabalho buscou identificar os aspectos que tecem o conceito de Qualidade de Vida no Trabalho ??? QVT sob a ??tica dos trabalhadores, no contexto de trabalho de um ??rg??o p??blico do Poder Executivo federal. A abordagem metodol??gica fundamentou-se na Ergonomia da Atividade Aplicada ?? Qualidade de Vida no Trabalho. O instrumento utilizado na pesquisa foi a parte qualitativa do macrodiagn??stico Invent??rio de Avalia????o de Qualidade de Vida no Trabalho/IA_QVT, validado no ??mbito da Administra????o P??blica brasileira. Participaram da pesquisa 37 trabalhadores de diferentes ??reas e v??nculos funcionais da Institui????o p??blica. A an??lise qualitativa dos dados, feita com base na an??lise de conte??do das representa????es dos respondentes, evidenciou que os trabalhadores relacionam QVT com os seguintes fatores: Rela????es socioprofissionais de trabalho harmoniosas; Condi????es adequadas de trabalho; Organiza????o eficaz do trabalho; Reconhecimento e crescimento profissional; Elo entre trabalho e vida social. A pesquisa ainda permitiu identificar os principais fatores que interferem nas representa????es de bem-estar e mal-estar da amostra de trabalhadores da institui????o. Este diagn??stico pode ensejar o interesse da Institui????o pelo aprofundamento da pesquisa para subsidiar a constru????o da pol??tica e do programa de QVT, calcado na ??tica de quem nela trabalha