Papers by Leandro Freitas
International braz j urol, 2007
Introduction: Chronic inflammation of longstanding duration has been linked to the development of... more Introduction: Chronic inflammation of longstanding duration has been linked to the development of carcinoma in several organ systems. It is controversial whether there is any relationship of inflammatory atrophy to prostate cancer. It has been suggested that the proliferative epithelium in inflammatory atrophy may progress to high-grade prostatic intraepithelial neoplasia and/or adenocarcinoma. The objective of our study is to compare on needle prostate biopsies of patients showing cancer the topographical relation of inflammatory atrophy and atrophy with no inflammation to adenocarcinoma. Materials and Methods: The frequency and extent of the lesions were studied on 172 needle biopsies of patients with prostate cancer. In cores showing both lesions, the foci of atrophy were counted. Clinicopathological features were compared according to presence or absence of inflammation. Results: Considering only cores showing adenocarcinoma, atrophy was seen in 116/172 (67.44%) biopsies; 70/116 (60.34%) biopsies showed atrophy and no inflammation and 46/116 (39.66%) biopsies showed inflammatory atrophy. From a total of 481 cores in 72 biopsies with inflammatory atrophy 184/481 (38.25%) cores showed no atrophy; 166/481 (34.51%) cores showed atrophy and no inflammation; 111/481 (23.08%) cores showed both lesions; and 20/481 (4.16%) showed only inflammatory atrophy. There was no statistically significant difference for the clinicopathological features studied. Conclusion: The result of our study seems not to favor the model of prostatic carcinogenesis in which there is a topographical relation of inflammatory atrophy to adenocarcinoma.
Brazilian Journal of Botany, 2013
Biota Neotropica, 2010
The Brazilian campos rupestres and campos de altitude are characterized by mosaics of vegetation ... more The Brazilian campos rupestres and campos de altitude are characterized by mosaics of vegetation types and are better represented above 900 m in the Espinhaço Range and above 1500-2000 m in the Serra do Mar and Serra da Mantiqueira. They bear high species richness at local and regional scales and numerous relicts and endemisms. These montane refuges, which are of particular interest to conservation in various ways, such as recharge and water regulation, control of erosion and sedimentation, biological singularity and recreational and spiritual values, are facing various threats such as erosion and soil instability, urban and agriculture sprawl, fires, removal of ornamental plants and mining. Moreover, these refuges are among the most vulnerable Brazilian ecosystems to global climate change, because the simple fact that with increasing temperature there is no possibility to migrate to higher altitudes. This paper discusses the potential impacts of the proposed new Brazilian Forest Code, currently under discussion in the Congress, for the conservation of biodiversity in these environments. Particularly we analyze the consequences of the removal of areas above 1800 m and on the hill tops as Permanent Preservation Areas (APPs), the reducing on the minimum width of the riparian vegetation and the exemption to smallholders of the conservation of native vegetation on their lands ("Legal Reserves"). Such proposals seem to assume that there is great individual injury on behalf of a very diffuse collective benefit, but do not consider the direct benefits of the current instruments of the Code to rural land owners. The losses of biodiversity and ecosystem services (e.g., water supply, presence of pollinators, natural pest control and timber and non-wood resources) with the conversion of habitat that may result from those changes are disproportionate to the potential economic benefit. The instruments proposed on the new Code, ultimately, lead to a model of space occupation with strong contrasts, it means, fully protected areas, such as parks and biological reserves, alternated with extensive areas devoid of vegetation except thin riparian forests. Such a scenario is detrimental to the conservation of biodiversity and for agricultural production, especially to smallholders, who benefit directly from environmental services. RIBEIRO, K.T. & FREITAS, L. Impactos potenciais das alterações no Código Florestal sobre a vegetação de campos rupestres e campos de altitude. Biota Neotrop. 10(4): http://www.biotaneotropica.org.br/v10n4/ pt/abstract?article+bn04310042010.
Revista de Enfermagem Referência, 2013
ABSTRACT Framework: Nursing is involved in the main health actions in the context of basic care a... more ABSTRACT Framework: Nursing is involved in the main health actions in the context of basic care and the use of planning, work organization and management for the development of nursing activities. Objective: to understand the conceptions of nurses regarding planning, organization and management in basic care, as published in national and international scientific journals. Methods: integrative literature review, as proposed by Ganong, with collection of data in August of 2011 through scientific articles produced by nurses in the period 1989-2011. Results: 258 articles were located, with13 studies being selected and analyzed from a hermeneutical-dialectic perspective. The data were classified into the following categories: planning, organization and management of the work of nursing and the healthcare team. Conclusion: the focus of the management of the work of the nurses is on administrative actions at the expense of care. However, the nurse is considered a competent professional to act in the management of the healthcare system, in the search for spaces of action and social visibility.
International Braz J Urol, 2007
INTRODUCTION: Chronic inflammation of longstanding duration has been linked to the development of... more INTRODUCTION: Chronic inflammation of longstanding duration has been linked to the development of carcinoma in several organ systems. It is controversial whether there is any relationship of inflammatory atrophy to prostate cancer. It has been suggested that the proliferative epithelium in inflammatory atrophy may progress to highgrade prostatic intraepithelial neoplasia and/or adenocarcinoma. The objective of our study is to compare on needle prostate biopsies of patients showing cancer the topographical relation of inflammatory atrophy and atrophy with no inflammation to adenocarcinoma. MATERIALS AND METHODS: The frequency and extent of the lesions were studied on 172 needle biopsies of patients with prostate cancer. In cores showing both lesions, the foci of atrophy were counted. Clinicopathological features were compared according to presence or absence of inflammation. RESULTS: Considering only cores showing adenocarcinoma, atrophy was seen in 116/172 (67.44%) biopsies; 70/116 (60.34%) biopsies showed atrophy and no inflammation and 46/116 (39.66%) biopsies showed inflammatory atrophy. From a total of 481 cores in 72 biopsies with inflammatory atrophy 184/481 (38.25%) cores showed no atrophy; 166/481 (34.51%) cores showed atrophy and no inflammation; 111/481 (23.08%) cores showed both lesions; and 20/481 (4.16%) showed only inflammatory atrophy. There was no statistically significant difference for the clinicopathological features studied. CONCLUSION: The result of our study seems not to favor the model of prostatic carcinogenesis in which there is a topographical relation of inflammatory atrophy to adenocarcinoma.
Endocrine Pathology, 1998
Forty-seven thyroids obtained at autopsy from patients with acquired immunodeficiency syndrome (A... more Forty-seven thyroids obtained at autopsy from patients with acquired immunodeficiency syndrome (AIDS) with no clinical manifestations of thyroid disease were analyzed systematically in order to determine the frequency and the major pathological characteristics of thyroid involvement in these individuals. The glands were obtained from 38 men and 9 women aged (on average) 33.6 yr. The specimens were weighed, measured, and evaluated after fixation in formalin. Histological examination was performed on at least 10 macroscopically normal and altered areas. The anatomopathological lesions detected in 29 glands (61.7%) were chronic nonspecific focal inflammation (48.2%); mycobacteriosis and colloid goiter (17.2%); histoplasmosis, cryptococcosis, and lipomatosis (13.7%), and paracoccidioidomycosis and hyperplastic nodules (3.4%). Although thyroid disease had not been clinically diagnosed, thyroid involvement was elevated (61.7%) and in 14 cases (29.7%) it was related to the immunodeficiency, with mycobacteria being the most common opportunistic agents. There appears to be no report of the association of lipomatosis with AIDS, although this was a frequent finding in the present study (13.7%), exceeding by far the rates reported in the literature (1–2%). Thus, thyroid lesions are frequent in AIDS patients, occurring in two thirds of the patients studied, especially those with disseminated infection.
International Journal of Surgical Pathology, 2005
Diagnostic criteria for intracapsular carcinoma ex pleomorphic adenoma (CXPA) are subjective and ... more Diagnostic criteria for intracapsular carcinoma ex pleomorphic adenoma (CXPA) are subjective and vary among authors. Biomarker analysis, which could provide more objective evaluation of these tumors, has rarely been studied in intracapsular CXPA. Immunohistochemical evaluation of c-erbB-2, p53 protein, bcl-2, and Ki-67 was performed in 8 cases of CXPA at an early phase of malignant transformation (4 intracapsular and 4 minimally invasive) and in 17 pleomorphic adenomas (PA). In all cases of CXPA, p53 and Ki-67 were demonstrated predominantly in luminal cells of benign and malignant areas, significantly more in the latter. Few benign myoepithelial cells were p53 positive. c-erbB-2 reactivity was strongly associated with atypical luminal cells. Bcl-2 expression was weak and focal in malignant areas from 2 cases. In conclusion, both p53 and c-erbB-2 proteins appear to be involved at an early stage of malignization of PA. In PA with atypical cells, evaluation of the expression of these 2 markers provides more objective criteria for the diagnosis of intracapsular CXPA.
Journal of Urology, 2008
At an International Society of Urological Pathology consensus conference in 2005 the Gleason grad... more At an International Society of Urological Pathology consensus conference in 2005 the Gleason grading system for prostatic carcinoma underwent its first major revision. We compared the concordance of pattern and change of prognostic groups for the conventional and the modified Gleason grading, and checked the discriminative power of the modified Gleason grading.The grading was based on 172 prostatic needle biopsies of patients subsequently undergoing radical prostatectomy. Four prognostic Gleason grading groups were considered, divided into scores of 2–4, 5–6, 7 and 8–10. To check the discriminative power of the modified Gleason grading we compared the time of biochemical (prostate specific antigen) progression-free outcome according to prognostic groups between standard and revised grading.The greatest impact of the International Society of Urological Pathology consensus recommendations for Gleason grading was seen on the secondary pattern which had the lowest percentage of concordance and was reflected in a change toward higher Gleason prognostic groups. Of 172 patients in whom the Gleason prognostic group was changed (to higher grades) based solely on the consensus criteria, 46 (26.7%) had higher preoperative prostate specific antigen, more extensive tumors and positive surgical margins, and higher pathological stage. The revised Gleason grading identified in this series a higher number of patients in the aggressive prognostic group Gleason score 8–10 who had a significantly shorter time to biochemical progression-free outcome after radical prostatectomy (log rank p = 0.011).The findings of this study indicate that the recommendations of the International Society of Urological Pathology are a valuable refinement of the standard Gleason grading system.
International Urology and Nephrology, 2004
Background: Recent studies have questioned the high risk for disease recurrence in cases of bladd... more Background: Recent studies have questioned the high risk for disease recurrence in cases of bladder neck involvement by prostate cancer (pT4 disease). Design: The study was based on 141 patients submitted to radical prostatectomy. PSA-recurrence was defined as 0.5 ng/ml or rising at three different examinations. Bladder neck invasion was correlated to Gleason score (Results: Bladder neck invasion was seen in 30/141 (21.27%) patients; 9 (6.38%) had also concomitant positive surgical margins in the sections. Extraprostatic extension was seen in 39/141 (27.65%) and seminal vesicle invasion in 18/141 (12.76%) patients. Patients with bladder neck invasion significantly correlated to Gleason score (P=0.04), preoperative PSA (P P=0.04). No correlation was found to age (P=0.44), race (P=0.12) and positive urethral or lateral margins (P=0.32). The PSA-recurrence relative risk in patients with bladder neck invasion was 0.17 (P=0.68), with extraprostatic extension 0.53 (P=0.47) and with seminal vesicle invasion 5.76 (P=0.02). Conclusions: Bladder neck involvement correlates with pathologic unfavorable findings on radical prostatectomy specimens as well as to preoperative PSA levels. However, the PSA-recurrence risk associated with bladder neck involvement (pT4) was similar to extraprostatic extension (pT3a) and substantially lower than seminal vesicle invasion (pT3b). The findings favor a need for downstaging of bladder neck involvement in the next version of the TNM system. The method proposed for tumor extent evaluation is simple and accessible to all pathologists working in routine pathology laboratories.
International Urology and Nephrology, 2000
Objectives To find whether any particular method of measuring cancer extent on needle prostatic b... more Objectives To find whether any particular method of measuring cancer extent on needle prostatic biopsies is superior to others in predicting pathological stage >T2 and biochemical recurrence following radical prostatectomy. Materials and methods The study was based on 168 extended biopsies and the correspondent step-sectioned surgical specimens. Tumor extent was evaluated as: (1) number and percentage of cores with carcinoma; (2) total length and percentage of cancer in mm in all cores; and (3) the greatest length and percentage of cancer in a single core. Results All measurements significantly predicted stage >pT2 using logistic regression. With the exception of the greatest length and percentage of cancer in a single core, all other methods were also associated with a higher risk for biochemical recurrence (Cox method). Percentage of length of carcinoma in all cores was significantly and consistently stronger than other measures in all comparisons and combined to preoperative PSA and Gleason grade in multivariate analysis gained prediction for pathologic stage >T2 and was independent of risk of biochemical recurrence. Conclusions Percentage of total length of carcinoma in mm in all cores of a needle biopsy had the strongest predictive positive value for stage >pT2 and risk for biochemical recurrence following radical prostatectomy. Combined with preoperative PSA and Gleason grade on biopsy may improve the predictive value for stage >pT2.
International braz j urol, 2007
Introduction: Chronic inflammation of longstanding duration has been linked to the development of... more Introduction: Chronic inflammation of longstanding duration has been linked to the development of carcinoma in several organ systems. It is controversial whether there is any relationship of inflammatory atrophy to prostate cancer. It has been suggested that the proliferative epithelium in inflammatory atrophy may progress to high-grade prostatic intraepithelial neoplasia and/or adenocarcinoma. The objective of our study is to compare on needle prostate biopsies of patients showing cancer the topographical relation of inflammatory atrophy and atrophy with no inflammation to adenocarcinoma. Materials and Methods: The frequency and extent of the lesions were studied on 172 needle biopsies of patients with prostate cancer. In cores showing both lesions, the foci of atrophy were counted. Clinicopathological features were compared according to presence or absence of inflammation. Results: Considering only cores showing adenocarcinoma, atrophy was seen in 116/172 (67.44%) biopsies; 70/116 (60.34%) biopsies showed atrophy and no inflammation and 46/116 (39.66%) biopsies showed inflammatory atrophy. From a total of 481 cores in 72 biopsies with inflammatory atrophy 184/481 (38.25%) cores showed no atrophy; 166/481 (34.51%) cores showed atrophy and no inflammation; 111/481 (23.08%) cores showed both lesions; and 20/481 (4.16%) showed only inflammatory atrophy. There was no statistically significant difference for the clinicopathological features studied. Conclusion: The result of our study seems not to favor the model of prostatic carcinogenesis in which there is a topographical relation of inflammatory atrophy to adenocarcinoma.
Virchows Archiv, 2010
Partial atrophy is the most common benign lesion that causes difficulty in the differential diagn... more Partial atrophy is the most common benign lesion that causes difficulty in the differential diagnosis with adenocarcinoma of the prostate. Very few studies described, illustrated, and discussed the concomitance of partial atrophy with complete atrophy in prostatic needle biopsies. The study group comprised 75 needle prostatic biopsies corresponding to 67 patients. Focal prostatic atrophy was present in all biopsies. Complete atrophy was subtyped into simple atrophy, sclerotic atrophy, and hyperplastic atrophy (or postatrophic hyperplasia). We analyzed the presence of inflammation in the atrophic foci and immunohistochemistry was performed for p63, 34βE12, and PSA. Partial atrophy and complete atrophy were present concomitantly in 47/75 (63%) biopsies. In 20/75 (27%) biopsies, there were areas with mergence of partial atrophy and complete atrophy. We illustrate morphologic transitions between these lesions in the same gland. Using immunohistochemistry, the aberrant phenotypic expression in the secretory compartment in all subtypes of complete atrophy highlighted the morphologic transitions between partial and complete atrophies in the same gland. An intriguing finding was the absence of chronic inflammation in partial atrophy foci as well as in areas of mergence between these lesions. Inflammation was present only in isolated complete focal atrophy foci. Partial atrophy seems to be part of a morphologic spectrum of focal prostatic atrophy and probably precedes complete atrophy. The question of whether the inflammation produces tissue damage and prostatic atrophy or whether some other insults like ischemia induces the tissue damage and atrophy directly, with inflammation occurring secondarily, is still unsettled.
Brazilian Journal of Botany, 2013
International Urology and Nephrology, 2009
Introduction It is controversial whether microscopic invasion of the bladder neck (BN) has a high... more Introduction It is controversial whether microscopic invasion of the bladder neck (BN) has a high risk for biochemical progression following radical prostatectomy (RP). The tumor, node, and metastasis (TNM) classification for prostate cancer considers BN involvement to be pT4 disease, equivalent to rectal or external sphincter invasion, however, it does not specify whether the invasion is macroscopic or microscopic. Materials and methods Clinicopathological findings were studied from 290 patients submitted to RP. The time to biochemical (prostate-specific antigen, PSA) progression-free outcome for patients with BN invasion was compared to patients with extraprostatic extension (EPE) or seminal vesicle invasion (SVI). A univariate Cox proportional hazards model was created and a final multivariate Cox proportional hazards model was developed to assess the influence of several variables simultaneously. Results BN invasion was present in 55/290 (18.96%) surgical specimens and 18/290 (6.2%) also showed positive surgical margins. Patients with microscopic BN invasion had significantly higher preoperative PSA, higher Gleason score, higher apical and circumferential positive surgical margins, more advanced pathological stage, and more extensive tumors. At 5 years 42%, 40%, and 27% of the patients with BN invasion, extraprostatic extension (EPE), and seminal vesicle invasion (SVI), respectively, were free of biochemical recurrence following RP. In multivariate analysis, BN invasion did not contribute for a higher relative hazard of PSA recurrence when added to EPE or SVI. Conclusion BN invasion is associated with adverse clinicopathological findings. However, the biochemical-free outcome following RP is similar to patients with EPE but significantly better than patients with SVI. The findings of this study do not favor considering microscopic bladder neck invasion as stage pT4 but, probably, stage pT3a.
Biota Neotropica, 2010
The Brazilian campos rupestres and campos de altitude are characterized by mosaics of vegetation ... more The Brazilian campos rupestres and campos de altitude are characterized by mosaics of vegetation types and are better represented above 900 m in the Espinhaço Range and above 1500-2000 m in the Serra do Mar and Serra da Mantiqueira. They bear high species richness at local and regional scales and numerous relicts and endemisms. These montane refuges, which are of particular interest to conservation in various ways, such as recharge and water regulation, control of erosion and sedimentation, biological singularity and recreational and spiritual values, are facing various threats such as erosion and soil instability, urban and agriculture sprawl, fires, removal of ornamental plants and mining. Moreover, these refuges are among the most vulnerable Brazilian ecosystems to global climate change, because the simple fact that with increasing temperature there is no possibility to migrate to higher altitudes. This paper discusses the potential impacts of the proposed new Brazilian Forest Code, currently under discussion in the Congress, for the conservation of biodiversity in these environments. Particularly we analyze the consequences of the removal of areas above 1800 m and on the hill tops as Permanent Preservation Areas (APPs), the reducing on the minimum width of the riparian vegetation and the exemption to smallholders of the conservation of native vegetation on their lands ("Legal Reserves"). Such proposals seem to assume that there is great individual injury on behalf of a very diffuse collective benefit, but do not consider the direct benefits of the current instruments of the Code to rural land owners. The losses of biodiversity and ecosystem services (e.g., water supply, presence of pollinators, natural pest control and timber and non-wood resources) with the conversion of habitat that may result from those changes are disproportionate to the potential economic benefit. The instruments proposed on the new Code, ultimately, lead to a model of space occupation with strong contrasts, it means, fully protected areas, such as parks and biological reserves, alternated with extensive areas devoid of vegetation except thin riparian forests. Such a scenario is detrimental to the conservation of biodiversity and for agricultural production, especially to smallholders, who benefit directly from environmental services. RIBEIRO, K.T. & FREITAS, L. Impactos potenciais das alterações no Código Florestal sobre a vegetação de campos rupestres e campos de altitude. Biota Neotrop. 10(4): http://www.biotaneotropica.org.br/v10n4/ pt/abstract?article+bn04310042010.
Virchows Archiv, 2010
Partial atrophy is the most common benign lesion that causes difficulty in the differential diagn... more Partial atrophy is the most common benign lesion that causes difficulty in the differential diagnosis with adenocarcinoma of the prostate. Very few studies described, illustrated, and discussed the concomitance of partial atrophy with complete atrophy in prostatic needle biopsies. The study group comprised 75 needle prostatic biopsies corresponding to 67 patients. Focal prostatic atrophy was present in all biopsies. Complete atrophy was subtyped into simple atrophy, sclerotic atrophy, and hyperplastic atrophy (or postatrophic hyperplasia). We analyzed the presence of inflammation in the atrophic foci and immunohistochemistry was performed for p63, 34betaE12, and PSA. Partial atrophy and complete atrophy were present concomitantly in 47/75 (63%) biopsies. In 20/75 (27%) biopsies, there were areas with mergence of partial atrophy and complete atrophy. We illustrate morphologic transitions between these lesions in the same gland. Using immunohistochemistry, the aberrant phenotypic expression in the secretory compartment in all subtypes of complete atrophy highlighted the morphologic transitions between partial and complete atrophies in the same gland. An intriguing finding was the absence of chronic inflammation in partial atrophy foci as well as in areas of mergence between these lesions. Inflammation was present only in isolated complete focal atrophy foci. Partial atrophy seems to be part of a morphologic spectrum of focal prostatic atrophy and probably precedes complete atrophy. The question of whether the inflammation produces tissue damage and prostatic atrophy or whether some other insults like ischemia induces the tissue damage and atrophy directly, with inflammation occurring secondarily, is still unsettled.
Revista de Enfermagem Referência, 2013
ABSTRACT Framework: Nursing is involved in the main health actions in the context of basic care a... more ABSTRACT Framework: Nursing is involved in the main health actions in the context of basic care and the use of planning, work organization and management for the development of nursing activities. Objective: to understand the conceptions of nurses regarding planning, organization and management in basic care, as published in national and international scientific journals. Methods: integrative literature review, as proposed by Ganong, with collection of data in August of 2011 through scientific articles produced by nurses in the period 1989-2011. Results: 258 articles were located, with13 studies being selected and analyzed from a hermeneutical-dialectic perspective. The data were classified into the following categories: planning, organization and management of the work of nursing and the healthcare team. Conclusion: the focus of the management of the work of the nurses is on administrative actions at the expense of care. However, the nurse is considered a competent professional to act in the management of the healthcare system, in the search for spaces of action and social visibility.
Urology, 2010
associated with the excretion of stone-forming constituents in urine, which is significantly high... more associated with the excretion of stone-forming constituents in urine, which is significantly higher than that observed in their normal-weighted counterparts. 3 We believe that further studies are certainly needed, which would deal with true obese as well as morbid obese children so as to outline the clear effect of increased body weight on urinary levels of stone-forming risk factors.
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Papers by Leandro Freitas