Search

Resumo: Num período de quinze anos, entre 1990 e 2004, foram diagnosticados 701 adenocarcinomas primários do pulmão no Serviço de Anatomia Patológica do Hospital da Universidade de Coimbra e 382 metástases de carcinomas, com predomínio do cólon (119) e mama (66). Os adenocarcinomas do pulmão tiveram um aumento relativo no sexo masculino, com crescimento de 16 casos em 1990 para 49 em 2004, e no sexo feminino verificou-se um aumento de 12 para 37 no mesmo período e, assim, a partir de 2001, a incidência foi equivalente em ambos os sexos.Também nos últimos quatro anos, o grupo etário de incidência dos adenocarcinomas passou para os 70 anos, havendo casos diagnosticados em doentes com idade superior a 80 anos.Acompanhando o estudo numérico dos adenocarcinomas, foi feita a respectiva reclassificação histológica para aplicação dos critérios de diagnóstico estabelecidos pela classificação da OMS 1999-2004 para os tumores do pulmão, pleura, timo e coração. A incidência dos carcinomas bronquíoloalveolares foi naturalmente maior no sexo feminino, enquanto no sexo masculino, se verificou um maior número de adenocarcinomas acinares. Estas conclusões foram retiradas dos diagnósticos obtidos nas peças cirúrgicas e quando em biópsias cirúrgicas se considerou a amostra representativa. O estadiamento cirúrgico predominou entre IIA e IIIB e, em 109 casos, o diagnóstico possível foi apenas de adenocarcinoma do pulmão, por falta de amostragem e com imuno-histoquímica concordante.Rev Port Pneumol 2006; XII (3): 255-268 Abstract: A study of 701 primary adenocarcinomas of the lung was made at the Department of Pathology of the Hospital da Universidade de Coimbra for a period of fifteen years, between 1990 and 2004. In the same period 382 metastases were diagnosed, mainly from colon (119) and breast (66). The incidence of primary adenocarcinomas varied from 16 cases in 1990 to 49 cases in men and from 12 to 37 cases in women in that period. From 2001 onwards, the incidence was almost coincident in both genders. In the last four years, since 2001, patients were in the seventies at the time of diagnosis and a considerable number of cases were diagnosed after 80 years of age.The criteria defined by the WHO classification of Tumours of the Lung, Pleura, Thymus and Heart 2004 were applied to the primary adenocarcinomas of the lung and as was expected, bronchioloalveolar carcinomas had its incidence in women while acinar adenocarcinomas were diagnosed mainly in men. These conclusions were obtained via surgical specimens and when surgical biopsies were representative and those were mainly in stage IIB and IIIA. A number of 109 cases had the final diagnosis of adenocarcinoma of the lung based on morphology and immunohistochemistry criteria.Rev Port Pneumol 2006; XII (3): 255-268 Palavras-chave: Adenocarcinoma do pulmão, metátases pulmonares, classificação WHO, Key-words: Adenocarcinoma of the lung, pulmonary metastasis, WHO classification

WOS:000313318000032 (Nº de Acesso Web of Science) In many countries, but particularly in Portugal, coastal conditions are already endangered by flooding and erosion, both likely to increase as a result of climate change. This daunting prospect raises critical questions of sustainability; social justice; genuine public participation and social learning; effective financing for long term social and economic benefit; connected polycentric governance; and the appropriate use of scientific knowledge bonded to public and political trust. While the development of most shorelines is nominally shaped by public administrative action, rapid coastal migration and excessive economic concentration have turned many threatened coastlines into a stage for settlement hazard and institutional chaos. In Portugal, despite clear evidence of increasing flooding and erosion, appropriate management responses are proving inadequate, both in the turbulent planning framework and in the scarce financial provision for future safeguard. The only plausible alternatives seem to lie in the processes of progressive adaptive governance, involving the trust and full participation of local communities; strongly supported scientific assessments of threat and safety; and fresh approaches to finding suitable funding sources. However, as evident from interviews with key actors in coastal planning in Portugal, the lack of policy clarity and political will, the weak science and poor coordination of stakeholders, combined with the particular regenerating coastal cultures of these communities, make any organised adaptive approaches highly problematic. This consequently places more emphasis on the rich cultural meanings of coastal occupation; of national identity in a time of economic crisis; of social justice in a period of reduced coastal maintenance funding; and of a more measured and sequential approach to an adaptive coastal governance.