Background : DiaRem score consists in preoperative model for predicting remission of type 2 diabetes mellitus in obese patients who underwent gastric bypass. Aim : To evaluate the applicability of DiaRem comparing the scores obtained preoperatively with remission of T2DM after surgery. Method : Preoperative parameters such as age, use of insulin, oral hypoglycemic agents and glycated hemoglobin, were retrospectively evaluated in diabetic patients undergoing gastric bypass during the period between July 2012 to July 2013. Through these data the DiaRem score were applied. The results of fasting blood glucose and glycated hemoglobin were requested prospectively. Results : Were selected 70 patients; the remission of T2DM after surgery was found in 42 (60%) and no remission in 28 (40%). Checking the final score, it was observed that: from 0 to 2 points, 94.1% of patients remitted completely; between 3 and 7 had remission in 68.9%, of which 42.8% complete; from 8 to 12, 57.1% achieved complete remission; between 13 to 17, 87.5% did not achieve remission and was not seen this complete remission group; between 18 to 22, 88.9% were not remitted. Conclusion : The DiaRem score showed appropriate tool to assess remission of T2DM in obese patients who will undergo gastric bypass.

The authors report an unusual case of disseminated tungiasis in a 52-year-old patient living in the city of Campo Grande, state of Mato Grosso do Sul, who had crusted-papular-nodular lesions located in feet, hands, and right thigh. Diagnosis was confirmed by dermoscopy and anatomopathological examination.

RESUMOIntrodução: O melanoma cutâneo (MC) é a terceira neoplasia mais frequente na pele, entretanto é a de pior prognóstico. Mesmo sendo pouco prevalente, representa uma séria ameaça de saúde pública em virtude de ocasionar altas taxas de morbimortalidade. Objetivo: O objetivo deste estudo é realizar uma triagem nos prontuários de pacientes diagnosticados com MC durante cinco anos em um serviço especializado em câncer de pele da cidade de Curitiba/PR, a fim de conhecer as características desta neoplasia nessa população. Métodos: Realizou-se uma análise restrospectiva através da verificação de prontuários de pacientes com MC, diagnosticados no período compreendido entre janeiro de 2007 e dezembro de 2011, em um serviço especializado em câncer de pele da cidade de Curitiba/PR. Resultados: A amostra consistiu em 23 casos de MC de sítio primário, sendo lentigo maligno (43,4%), extensivo superficial (26%), nodular (17,6%) e não especificado (13%). Dentre estes 3 com Breslow ≥4mm, todos em pacientes do sexo masculino. Em contrapartida, em 43,4% dos pacientes não foi possível aplicar o índice de Breslow, em virtude do lentigo maligno melanoma caracterizar-se por ser in situ. Identificou-se homens com diagnóstico mais tardio em relação às mulheres, já que 80% deles possuíam um Breslow >1mm. Conclusão: Sugere-se maior divulgação dos cuidados com a exposição solar e melhor formação para que o médico clínico geral seja um identificador de MC o mais precocemente possível, podendo, assim, encaminhar o paciente para uma abordagem com maior possibilidade de cura.Palavras-Chave: Epidemiologia; Diagnóstico; Melanoma.ABSTRACT Introduction: The cutaneous melanoma (CM) is the third most common skin cancer, however, has the worst prognosis. Even being little prevalent, is a serious worring due to high morbidity and mortality rates. Objective: To perform a screening in the medical records of MC diagnoses for five years in a skin cancer specialized center in Curitiba / PR, with the view to know the characteristics of this cancer in this population. Methods: A retrospective analysis was performed by checking records of patients with MC, diagnosed in the period between January 2007 and December 2011, in a skin cancer specialized center in Curitiba / PR. Results: 23 patients were selected, and lentigo malign (43.4%), superficial spreading (26%), nodular (17.6%) and unspecified (13%). Among these 3 with Breslow ≥4mm, all in male patients. However, in 43.4% of patients was not possible to apply the Breslow thickness, due to lentigo malign melanoma characterized by being in situ. Men were diagnosed later in relation to women, since 80% of them had a Breslow> 1mm. Conclusion: It is suggested wider disclosure of sun protection and better training for the primary care physician, and thus can route the patient to an approach with greater chances of cure.

The bilateral perialar advancement flap in ascending is a good option for restoring complex upper lip defects. We report a patient presenting with a basal cell carcinoma in the upper lip filter, submitted to reconstruction with bilateral perialar advancement flap in ascending: a technique that is easy to perform, under local anesthesia and with excellent esthetic results.

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