Objective: To select cases of bilateral breast carcinoma (BBC) of patients seen at Hospital de Clínicas of Paraná, besides recognizing clinical and family characteristics, histological and immunohistochemical pattern, and incidences of synchronic/metachronic tumor in these patients. Method: Observational and analytical study of BBC cases of patients treated at Hospital de Clínicas of Paraná, from 2003 to 2019, developed from the analysis of medical records. Result: A total of 42 patients with BBC were selected. The incidence of BBC was 3.64%. All patients were women, mostly of white skin color and postmenopausal, with an average age of 51.82 years. Half patients showed a positive family history for cancer, with breast cancer present in 46%, ovarian cancer in 16%, and other topographies in 68%. In this sample, the synchronous tumor was present in 55% of patients, and the metachronous tumor, in 45%. Regarding patients’ initial clinical staging, 61% had a locally advanced tumor at diagnosis. Both in the group of synchronic and metachronic tumors, the ductal subtype was the most frequent. Regarding the immunohistochemical subtype, patients in both groups had Luminal B tumors more frequently. In the group of metachronic tumors, the average time between the diagnosis of the first tumor and the second tumor was 5.68 years. Conclusion: In this sample, BBC is associated with a relevant family history, with a synchronic presentation pattern, from histology to ductal and immunohistochemistry to Luminal B as the most frequent.

Introduction: Bilateral breast cancer (BBC) is a rare clinical entity. This pattern of neoplasia can be considered synchronous (simultaneous) or metachronous (1 month to 1 year later). Objective: To select cases of BBC patients seen at HC-UFPR and to recognize in these patients clinical and family characteristics, histological and immunohistochemical patterns, and incidences of synchronous/metachronous occurrences. Method: An observational and analytical study of BBC cases of patients treated at HC-UFPR, from January 2003 to October 2019, based on the analysis of medical records, was developed. Result: 42 patients with BBC were selected and 4 patients were excluded from the study due to incomplete information in the medical record. The incidence of BBC in the surveyed period was 3.64%. All patients are women with a mean age of 51.82 years. White ethnicity is the most prevalent one (82%). With regard to menopausal status, 42% of the subjects are pre-menopausal and 58%, post-menopausal. Regarding parity, only 16% were nulliparous. Half of the patients have a positive family history for neoplasms, with breast cancer present in 46%, ovarian cancer in 16%, and other topography in 68%. In this sample, the synchronous tumor was present in 55% of the patients and the metachronous tumor in 45%. Regarding the patients’ initial clinical staging, 61% presented with locally advanced tumor at the first consultation. In the group of synchronous tumors, the ductal type was the most frequent one (93%), followed by the lobular type (7%). Regarding immunohistochemical subtypes, patients had Luminal B tumors (43%), followed by HER (29%), Triple negative (24%), and Luminal A (5%). Comparing the immunohistochemical profile in both tumors, 62% were in agreement and 48%, in disagreement. In the group of metachronous tumors, the mean time between the diagnosis of the first tumor and that of the second tumor was 5.68 years. The most common histological type was ductal carcinoma (73%), followed by lobular carcinoma (11%), medullary carcinoma (9%), and metaplastics (7%). Regarding the immunohistochemical profile, the most present was Luminal B in 32%, Luminal A in 29%, Triple negative in 24%, and HER 2 in 15%. The immunohistochemical profile was consistent in only 29% of the patients. Conclusion: In this sample, BBC is associated with relevant family history, with a pattern of presentation, synchronous; frequently, ductal is histological and Luminal B is immunohistochemistry.

Historicamente, desde que Fitz, em 1886, estabeleceu as bases palológicas da apendicite aguda, o tratamento dessa condição envolvia necessariamente uma cirurgia (apendicetomia) 2 . A apendicite é comum, acomete em média 300.000 pessoas por ano nos EUA 3 , sendo que aproximadamente 7 a 14% da população em geral será acometida durante a vida. Por ser frequente e causar complicações graves (inclusive morte), o impacto da resolução do quadro com cirurgia foi importante o bastante para abafar o uso de outros tratamentos possíveis, como antibióticos 2 . O manejo da apendicite está em evolução. Novas técnicas diagnósticas e cirúrgicas (laparoscópicas principalmente) foram incorporadas à prática. Nesse contexto, a tomografia computadorizada de abdômen conseguiu diagnosticar com acurácia próxima de 100% 2 , diminuindo a quantidade de cirurgias ditas brancas 3 ou sem apêndice inflamado. Com o avanço da medicina, várias evidências sobre uso racional de antibióticos como tratamento dessa doença foram se acumulando 5-9 . Mas como questionar o tratamento cirúrgico que possui eficácia de quase 100%? E além disso, os estudos com antibióticos mostravam uma taxa de recorrência significativa, diminuindo o poder para questionamento de uma prática bem estabelecida. Para que não haja implicações éticas na condução de estudos que envolvam intervenções bem consolidadas, é necessário utilizar desenhos de estudos particulares. Os estudos de não-inferioridade propõe-se a comparar tratamentos, sendo um deles o padrão 9 . Possuem a premissa de que: "esse tratamento é tão bom quanto o antigo". Nesse sentido, o APPAC trial 1 foi realizado, visando superar limitações de estudos anteriores. Trata-se de um estudo randomizado, controlado, aberto e de nãoinferioridade, feito em 6 centros da Finlândia, selecionando pacientes de 2009 a 2011, com um acompanhamento de no mínimo um ano. Como critério obrigatório de inclusão no estudo era necessário tomografia computadorizada (TC) de abdômen com apendicite, mas sem evidências de complicações como abscesso, necrose e perfuração. Foi testado a hipótese de que ertapenem 1g por 3 dias, seguido de levofloxacino (500mg 1 vez ao dia) e metronidazol (500mg 3 vezes ao dia), era comparável à cirurgia aberta (incisão de McBurney). O ojetivo primário era resolução da apendicite, ou seja, alta hospitalar sem necessidade de intervenção e sem recorrência do quadro em um ano. Como desfechos secundários: complicações após intervenção, recorrência após um ano, tempo afastado do trabalho, dor após intervenção, tempo de estadia no hospital e uso de JOURNAL