Colecistite aguda alitiásica

The authors report the case of a 14-year old male seen at the adult emergency room at Hospital da Restauração, presenting acute inflammation in the abdomen, secondary to acute appendicitis with local peritonitis. On the 8th postoperative day, he returned to the hospital with abdominal pain associated with fever and intense leukocytosis. Abdominal ultrasonography showed distended gallbladder with thickened walls, which suggests acute acalculous cholecystitis. The patient was submitted to surgery, which revealed an enlarged vesicle, thickened walls, and no calculi inside it. After theperformance of cholecystomy, the patient was dismissed on the 4th postoperative day. Os autores relatam o caso de um paciente de 14 anos, masculino, atendido na emergência de Adultos do Hospital da Restauração, com quadro de abdômen agudo inflamatório, secundário a apendicite aguda com peritonite localizada. No oitavo dia de pós-operatório, retornou ao hospital com dor abdominal associada à febre e intensa leucocitose. A ultra-sonografia abdominal revelou vesícula biliar distendida com paredes espessadas, sugestivo de colecistite aguda alitiásica. O paciente foi submetido à cirurgia, com achado de vesícula aumentada de volume, paredes espessadas, sem cálculos em seu interior. Realizada colecistectomia, tendo alta hospitalar no quarto diade pós-operatório

Latin American consensus on the treatment of head and neck cancer

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries

Colecistite aguda alitiásica

The authors report the case of a 14-year old male seen at the adult emergency room at Hospital da Restauração, presenting acute inflammation in the abdomen, secondary to acute appendicitis with local peritonitis. On the 8th postoperative day, he returned to the hospital with abdominal pain associated with fever and intense leukocytosis. Abdominal ultrasonography showed distended gallbladder with thickened walls, which suggests acute acalculous cholecystitis. The patient was submitted to surgery, which revealed an enlarged vesicle, thickened walls, and no calculi inside it. After theperformance of cholecystomy, the patient was dismissed on the 4th postoperative day. Os autores relatam o caso de um paciente de 14 anos, masculino, atendido na emergência de Adultos do Hospital da Restauração, com quadro de abdômen agudo inflamatório, secundário a apendicite aguda com peritonite localizada. No oitavo dia de pós-operatório, retornou ao hospital com dor abdominal associada à febre e intensa leucocitose. A ultra-sonografia abdominal revelou vesícula biliar distendida com paredes espessadas, sugestivo de colecistite aguda alitiásica. O paciente foi submetido à cirurgia, com achado de vesícula aumentada de volume, paredes espessadas, sem cálculos em seu interior. Realizada colecistectomia, tendo alta hospitalar no quarto diade pós-operatório

Laringectomia supracricóide (chep) para câncer glótico

OBJETIVOS: Com a intenção de se avaliar os resultados funcionais e terapêuticos da laringectomia supracricóide com crico-hióide-epiglote-pexia (CHEP) foram estudados 50 casos de pacientes com carcinoma epidermóide da glote classificados como T2/T3 submetidos a esta técnica em nossa instituição. MÉTODOS: Foi realizada uma análise retrospectiva entre 1996 e 1999. Classificamos 18 pacientes como T2N0M0 e 32 pacientes como T3N0M0. Quarenta e um pacientes foram submetidos a esvaziamento cervical seletivo lateral bilateralmente, quatro foram submetidos ao mesmo esvaziamento unilateralmente, e cinco não foram esvaziados. Analisamos as complicações e a sobrevida livre de doença pelo método de Kaplan-Meyer. RESULTADOS: Dez pacientes tiveram complicações pós-operatórias, dois foram tratados com complementação da laringectomia. Os 48 pacientes restantes mantiveram a via aérea normal, deglutição e a voz. Três pacientes no grupo submetido a esvaziamento cervical apresentaram linfonodo metastático. Quatro pacientes tiveram recidiva da doença, três com recidiva local, sendo dois tratados com laringectomia total e estão vivos e sem doença, o outro com doença avançada alcançou o óbito pela doença. O paciente que teve recidiva no pescoço foi tratado com esvaziamento cervical mais radioterapia e morreu com doença. Dois pacientes tiveram um segundo tumor primário em orofaringe, sendo um tratado com radioterapia paliativa e morreu com doença e o outro tratado com cirurgia está vivo e sem doença. A sobrevida livre de doença em três anos foi de 88% para pacientes T2 e 72% para pacientes T3. CONCLUSÕES: Esta técnica é útil no tratamento de casos selecionados de carcinoma epidermóide da glote T2/T3 sempre se considerando a extensão da doença. A incidência de complicações necessitando laringectomia total de resgate não compromete a funcionalidade desta técnica. A sobrevivência é comparável aos pacientes submetidos a laringectomia total e laringectomia "near-total"

Latin American Consensus on the Treatment of Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery—oral cavity, Clinical oncology—oral cavity, Head and neck surgery—oropharynx, Clinical oncology—oropharynx, Head and neck surgery—larynx, Head and neck surgery—larynx/hypopharynx, Clinical oncology—larynx/hypopharynx, Clinical oncology—recurrent and metastatic head and neck cancer, Head and neck surgery—reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries