BRAZIL - DISTRICT 4760 RYEP
Strategic Planning for
RYE Program
of District 4760 in
BRAZIL
Rtn. Ivan L. Vianna
District 4760 - BRAZIL
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP What is Strategic Planning in a
Rotary Youth Exchange Program?
Strategic planning is a disciplined effort to
produce fundamental decisions and actions that
shape and guide what RYEP is, what it does,
and why it does it, with a focus on the future.
It is a management tool that helps to
achieve good quality in YE Program.
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP It was not easy for District
4760 has a big area:
Our District 4760 had 6 meetings
from August 2007 to February 2008 in order to
accomplish its Strategic Planning for the Youth
Exchange Program for 2007-2012
It was also difficult to get together all members
of the District Committee plus its 3 District
Governors: the current, the incoming
and the elected one
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP MOREOVER, it does take
time to do it:
Strategic planning does not typically flow
smoothly from one step to the next.
It is a creative process, and the fresh insight
arrived at today might very well alter
the decision made yesterday.
Inevitably the process moves forward and back
several times before arriving at the final set of
decisions.
2008 LOS ANGELES YEO PRE CONVENTION
Basic Agenda
BRAZIL - DISTRICT 4760 RYEP
1- History of YEP & what is has been
2- Scenarios and mega trends related to YE
3- Definition of Mission and Vision for RYEP
4- SWOT Analysis
5- Developing Strategies, Goals and Objectives
6- Elaboration of Action Plans
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP
Our Mission was defined as:
The Mission of Rotary Youth
Exchange Program of District 4760
is to develop opportunities for,
safely and qualitatively, educating
young people to be compromised
on promoting Peace
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP
SWOT ANALYSIS
1- Strength: what are our D-4760 YEP internal
Strengths?
2- Weakness: what are our internal
Weaknesses?
3- Opportunities: what external
Opportunities might push YEP forward?
4- Threats: what external Threats might
hold D-4760 YEP back?
2008 LOS ANGELES YEO PRE CONVENTION
1- Strength: what are D-4760 YEP internal Strengths?
BRAZIL - DISTRICT 4760 RYEP
1- High credibility both inside and outside district
2- Well-structured Committee
3- YEOs are efficient and very enthusiastic
4- Good selection and orientation processes
5- Large experience: started in 1967
6- Self-sustained Program: 60 Outb. YE yearly
7- Diversity of partners abroad: over 50 districts.
2008 LOS ANGELES YEO PRE CONVENTION
2- Weakness: what are our internal Weaknesses?
BRAZIL - DISTRICT 4760 RYEP
1- Frequent changing of Chairperson
2- Concentration of inbound YE in Belo Horizonte
3- Club YEO not fully understand RYEP and not
always respond as quick as desirable
4- Few Clubs do participate, more should come in
5- Lack of interest of many Rotarians
6- Under pressure, Club YEO quit RYEP
7- Lack of Club YE Certification
2008 LOS ANGELES YEO PRE CONVENTION
3- Opportunities: what external Opportunities might
BRAZIL - DISTRICT 4760 RYEP push YEP forward?
1- More Rotary Clubs start to participate in YEP
2- YE parents become Rotarians
3- Explore more internet usage for better training
YEOs, host families and students
4- New partners from new countries
5- Growth of internationality of Rotary among
small Clubs of the district
6- World getting smaller and closer
2008 LOS ANGELES YEO PRE CONVENTION
4- Threats: what external Threats might hold D-4760
BRAZIL - DISTRICT 4760 RYEP YEP back?
Lose International credibility or RI Certification
Brazil`s Political, Social or Financial Instability
Bad world economy scenario due to oil crisis
A bad crisis management on YEP anywhere
may create bad reputation for RYEP
Lost of current self-sustained financial
condition
Unfeasibility for complying with a RI new
requirement such as liability insurance
Terrorist escalade anywhere in the world
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP
If you would you like to know more
about our Strategic Planning:
no time now,
please check it at
YEORESOURCE later
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP ROTARY STRATEGIC PLANNING
ENCOURAGE ROTARIANS TO ASK
THEMSELVES ABOUT ROTARY
THREE QUESTIONS:
1- WHERE ARE WE NOW?
2- WHERE DO WE WANT TO BE?
3- HOW DO WE GET THERE?
2008 LOS ANGELES YEO PRE CONVENTION
THANKS FOR YOUR ATTENTION
BRAZIL - DISTRICT 4760 RYEP
MUITO OBRIGADO PELA SUA ATENÇÃO
2008 LOS ANGELES YEO PRE CONVENTION
BRAZIL - DISTRICT 4760 RYEP
2008 LOS ANGELES YEO PRE CONVENTION
Carlos Alberto F. Ramos
HISTÓRIA CLÍNICA – paciente de
75 anos com dor abdominal
Sexo masculino, 75 anos, político, eleito presidente do
Brasil, antecedentes familiares de câncer intestinal
História de dores abdominais há uma semanas, que
se tornaram muito intensas. Com o diagnóstico
clínico de peritonite e apendicite aguda foi realizada
laparotomia exploradora. O diagnóstico cirúrgico e
AP foi diverticulite. Houve complicações pós-
operatórias (trombose mesentérica, necrose
intestinal, aderências) e foi realizada também uma
segunda cirurgia, com jejunostomia. Outras cinco
intervenções cirúrgicas foram realizadas em menos
de um mês. O óbito ocorreu em conseqüência de
edema pulmonar e septicemia
O Diagnóstico anatomopatológico foi alterado para
leiomioma infectado
TUMORES ESTROMAIS
GASTROINTESTINAL (GIST)
Constitutem a grande maioria dos
tumores mesenquimais do trato
gastrointestinal (GI). Expressa a
proteína protooncogênica c-kit
As células intersticiais de Cajal
(ICCs)
• Encontradas na parede do TGI
• ICCs são parte do sistema nervoso
autônomo, responsáveis pelo envio de
sinais nervosos para o TGI, com o
objetivo de estimular movimentos
peristálticos
Gastrointestinal stromal tumors (GIST)
• The most common form of mesenchymal tumors
arising from the gastrointestinal (GI) wall,
mesentery, omentum or retroperitoneum that
express the c-kit proto-oncogene protein
• The expression of c-kit (CD117) distinguishes
GIST from true leiomyomas, leiomyosarcomas,
and other mesenchymal tumors of the GI tract
• Stomach (60–70%) and small intestine (20–30%)
is the most common site for GIST
Imatinib mesylate, tyrosine
kinase inhibitor, is the first
effective drug with response
rate of 54% in the treatment
of metastatic GIST
Even in patients with large tumor,
response to imatinib mesylate can occur
rapidly
Rajiv M Mehta & cols. World Journal of Surgical
Oncology 2005, 3:11
Gastrointestinal stromal
tumors (GIST)
• Most (50-80%) GISTs arise because of a
mutation in a gene called c-kit.
• The c-kit/CD117 receptor is expressed on
ICCs and a large number of other cells,
mainly bone marrow cells, mast cells,
melanocytes and several others.
• In the gut, a mass staining positive for
CD117 is likely to be a GIST, arising from ICC
cells.
CARCINOGÊNESE
Mutação sequencial de gens
específicos (* )
• produção de proteínas anormais
(imunoistoquímica)
Acumulação de alterações
genéticas
(*) ras, myc, p53, p16, APC, DCC,
MAD, MADR
Carlos A. F. Ramos
IMUNOISTOQUÍMICA
indicações
Histogênese de neoplasias indiferenciadas
Identificação de linhagens celulares específicas
carcinoma
sarcoma
melanoma
linfoma
neuroendócrino
Vimentina – marcação
mesenquimal
NEOPLASIAS POUCO
DIFERENCIADAS
CITOCERATINAS
CARCINOMAS
CITOCERATINA DE ALTO
PESO MOLECULAR
CARCINOMA ESCAMOSO
34BE12
NEOPLASIAS POUCO
DIFERENCIADAS
MELANOMA
S100
HMB45
MELAN A
HMB45
NEOPLASIAS POUCO
DIFERENCIADAS
VIMENTINA
SARCOMAS
vimentina
NEOPLASIAS POUCO
DIFERENCIADAS
LINFOMAS Linfoma cutâneo
ALC (CD45)
CD3 (células T)
CD20 (células B)
VIMENTINA
Laboratório Virchow
João Pessoa - PB CD45 (ALC)
IMUNOISTOQUÍMICA
indicações
Origem de neoplasias
metastáticas
adenocarcinomas
carcinomas
indiferenciados
NEOPLASIAS
NEUROENDÓCRINAS
CARCINOMA DE
MERKEL
Imunoexpressão de
Citoceratina 20
Marcadores KER 20
neuroendócrinos
(TTF-1 negativo)
CARCINOMA OAT CELLS
PULMONAR:
POSITIVO PARA TTF-1
Imunoistoquímica - indicações
Prognóstico de
neoplasias
carcinoma
mamário
adenocarcinoma
endometrial
Marcadores prognósticos de
carcinoma mamário
• Receptores hormonais
• Índice proliferativo (Ki-67, PCNA)
• Oncogene c-erbB2
• Gen de supressão tumoral p53
• Angiogênese (CD34, CD31, fator VIII)
• Catepsina D
• Fatores de crescimento e seus receptores
• Sialyl-Tn
Carcinoma ductal infiltrante
Imunoexpressão difusa Imunoexpressão difusa
(nuclear) de receptor (citoplasmática) de
estrogênico em ca ductal c-erbB2 em carcinoma
infiltrante ductal infiltrante
Laboratório Virchow
João Pessoa - PB
TUMORES DE CÉLULAS
REDONDAS, PEQUENAS
• NEUROBLASTOMA
antígeno marcador de neuroblastoma
• RABDOMIOSSARCOMA
mioglobina, actina sarcomérica, desmina
• CARCINOMA NEUROENDÓCRINO
TTF-1, cromogranina, sinaptofisina
• SARCOMA DE EWING, PNET
CD99
NEOPLASIAS POUCO
DIFERENCIADAS
Células neoplásicas de melanoma CITOCERATINAS +
metastático em pleura
• Carcinomas
HMB45 VIMENTINA +
• sarcomas
• linfomas
ALC (CD45) +
• melanoma
S100+, HMB45+
ADENOCARCINOMA METASTÁTICO
• RECEPTORES MAMA, GENITAL FEM.
HORMONAIS
• PSA PRÓSTATA
• TIREOGLOBULINA TIREÓIDE
• FATOR DE PULMÃO, TIREÓIDE
TRANSCRIÇÃO TTF-1
• VIMENTINA RIM, ENDOMÉTRIO
PÂNCREAS
• CITOCERATINA 20 TUBO DIGESTÓRIO
MARCADORES DE SARCOMAS
MARCADORES MARCADORES
MUSCULARES ENDOTELIAIS
ACTINA DESMINA CD34 CD31
MIOGLOBINA FATOR VON WILLEBRAND
VIMENTINA
d
FIBROSSARCOMA
SARCOMA FIBROMIXÓIDE
VIMENTINA + CD34
TUMORES
DERMATOFIBROSSARCOMA (DFP) (MIO)FIBROBLÁSTICOS
TUMOR FIBROSO SOLITÁRIO
VIMENTINA + ACTINA
FIBROMATOSE
TUMORES MIOFIBROBLÁSTICOS
VIMENTINA + ACTINA + F XIIIa
DERMATOFIBROMA
Carlos A. F. Ramos
ANTICORPOS ANTI-CÉLULAS
MIOEPITELIAIS
• Proteína S-100, Actinas
• Citoceratina de alto peso
molecular
• Calponina
PATOLOGIA MAMÁRIA
– benignidade versus
malignidade
– definição de
microinfiltrações
– tumores mioepiteliais
Laboratório Virchow
João Pessoa - PB
Fator de transcrição TTF-1
• NEOPLASIAS TIREOIDEANAS
• diferenciadas - 100%
• carcinoma indiferenciado - 50%
• NEOPLASIAS PULMONARES
• adenocarcinomas - 65% a 75%
• carcinoma oat cell - 93%
• carcinóide atípico - 75%
MARCADORES LINFÓIDES PARA
LINFOMAS
• CD3 • CÉLULAS T
• CD20 • CÉLULAS B
• CD5 • CÉLULAS DO MANTO
• KI67 • BAIXO X ALTO GRAU
• CICLINA D1 • CÉLULAS DO MANTO
• BCL2 • FOLICULAR
• IGD • LLC, MANTO
• CADEIAS LEVE • MONOCLONAL X
(kappa e lambda) POLICLONAL
PROGNÓSTICO DOS LINFOMAS
• LINFOMA MALT • DOENÇA
LOCALIZADA
• LINFOMA DE • AGRESSIVA,
CÉLULAS MANTO DISSEMINADA
• LINFOMA • INTERMEDIÁRIO
LINFOCÍTICO
Lesão linfoepitelial
em linfoma MALT
CASO CLÍNICO
• Mulher, 68 anos
• Tumor localização
parauretral
• Aspecto microscópico
• Imunoistoquímica
(PSA)
• Cariótipo
Tumour of female paraurethral duct.
Immunohistochemical similarity with prostatic carcinoma.
• Virchows Arch A Pathol Anat Histopathol.
1987;411(4):395-8.
• A case of adenocarcinoma derived from a female
paraurethral duct is described. Morphologically the
tumour looked like a prostatic adenocarcinoma.
Furthermore, the tumour cells stained positively with
antibodies to prostatic specific antigen and prostatic
specific acid phosphatase. The patient was not a
hermaphrodite (karyotype).
• The tumour therefore represented female homology of
a prostatic adenocarcinoma
CONCLUSION
•Virchows Arch A Pathol Anat Histopathol. 1987;411(4):395-8.
• The female prostate is not a myth and is not
equivalent to Skene's glands. It is a rudimentary
organ located in the posterior wall of the distal
urethra. It has been found by several other observers
in up to 80% of females. It does explain detectable
serum PSA levels in females. As in the male, it can
become hyperplastic and neoplastic. This is the first
report of prostatichyperplasia and prostatic
carcinoma in the female
CONCLUSÃO
• Impacto da imunoistoquímica sobre:
Diagnóstico e histogênese de neoplasias
Detecção de micrometástases e
microinfiltrações
Prognóstico e adequação de protocolos de
tratamento oncológico
• NÃO EXISTE ANTICORPO ESPECÍFICO
PARA DISTINGUIR CÉLULA BENIGNA
DE CÉLULA MALIGNA
NOVA RESOLUÇÃO DO CFM
• Normas para
transporte de biópsias
e peças cirúrgicas
• Obrigatória a
identificação e
assinatura do
patologista em laudos Conselho Federal de Medicina
• Preenchimento correto Brasília, 08 de agosto de 2007
das requisições de
exames AP
NUNCA REAPROVEITAR FRASCOS DE SOROS
PARA TRANSPORTE DE MATERIAL BIOLÓGICO
SEMPRE UTILIZAR FRASCOS COM TAMPAS
RESOLUÇÃO CFM 1823/2007
Consulte em www.abralapac.org.br
PREENCHIMENTO CORRETO DAS
REQUISIÇÕES DE EXAMES AP
• ... Os diagnósticos em Patologia são atos médicos
complexos e devem ser executados com o
conhecimento do contexto clínico que o gerou...
• Artigo 5º. O preenchimento das requisições de
procedimentos diagnósticos deve expressar de forma
completa e clara todos os procedimentos solicitados
RESOLUÇÃO CFM 1823/2007
Consulte em www.abralapac.org.br
LAUDO ANATOMOPATOLÓGICO:
Ato médico em conformidade com a Resolução
CFM 1823/2007
• Artigo 7º. É obrigatória nos laudos
anatomopatológicos e citopatológicos a assinatura e
identificação clara do médico que realizou o exame
da(s) amostra(s).
• Artigo 8º. O médico assistente deverá orientar os
seus pacientes a encaminharem o material a ser
examinado para médico patologista inscrito no CRM
de seu estado