Diagnósticos anatomopatológicos de cirurgias eletivas no HPS-Sul/PAM3

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Comparação das incidências de tumores cutâneos malignos em pacientes submetidos à cirurgia ambulatorial no PACS nos períodos de 1998-1999 e 2000-2001

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Prevalência das patologias mais frequentes diagnosticadas por anatomopatológicos entre junho de 2000 e de 2001 em procedimentos realizados num posto de atendimento primário de Porto Alegre

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Colestase neonatal : atraso no encaminhamento de crianças para diagnóstico diferencial

Objetivo - O tratamento eficaz da atresia de vias biliares extrahepáticas exige que a diferenciação diagnóstica entre colestase neonatal de causa intra e extra-hepática seja realizada antes das primeiras oito semanas de vida. O objetivo do presente estudo foi avaliar a idade dos pacientes com colestase neonatal internados em um hospital geral para diferenciação diagnóstica da icterícia colestática. Métodos - Foram estudadas 49 crianças no Serviço de Pediatria do Hospital de Clínicas de Porto Alegre entre 1984 e 1991. O protocolo para esclarecimento diagnóstico seguido neste hospital inclui realização de cintilografia de vias biliares com Tc-99m DISIDA e posterior biópsia hepática, em cunha ou percutânea dependendo do resultado do teste cintilográfico. Foram comparadas as idades das crianças por ocasião dos procedimentos. Em 26 casos o estudo foi retrospectivo; em 23, prospectivo. Resultados - Os pacientes foram submetidos à cintilografia em média com 77,94 + 42,98 dias de vida. A biópsia hepática foi realizada cerca de 2 semanas após o teste cintilográfico. Apenas 6 pacientes (12,8% dos 47 casos) foram submetidos à biópsia antes das primeiras oito semanas de vida. Não houve diferença quanto à idade na data da cintilografia entre os pacientes estudados retrospectiva e prospectivamente. Conclusões - Ocorre atraso no encaminhamento dos pacientes para o diagnóstico diferencial da colestase neonatal e também na realização dos testes. A necessidade de hospitalizar para a execução dos procedimentos retarda ainda mais a elaboração diagnóstica, que deveria estar concluída antes das primeiras oito semanas de vida.Objective- An efficient treatment of extrahepatic biliary atresia demands that the diagnostic differentiation between intra- and extrahepatic neonatal cholestasis be performed by the eighth week of life. This study aimed at evaluate the age of the patients admitted to a general hospital for differential diagnosis of cholestatic jaundice. Methods- Forty nine children from the Pediatric Service at Hospital de Clínicas, in Porto Alegre, have been studied between 1984 and 1991, according to the protocol for diagnostic elucidation followed by this hospital, which includes biliary tract scintigraphy with Tc-99m DISIDA and, depending on its results, an wedge or percutaneous liver biopsy. The ages of the children have been compared on the occasion of the procedures. Twenty six cases have been studied retrospectively and 23, prospectively. Results- Both the patients with intrahepatic and extrahepatic cholestasis underwent scintigraphy, on average at over eight weeks (age 77.94 + 42.98 days) and the histopathological study of the liver was performed approximately two weeks after scintigraphy. Only six patients (12.8% of the 47 cases) underwent the liver biopsy before the first eighth week of life. Conclusions- A delay was observed in referring patients for differential diagnosis of neonatal cholestasis and the performance of tests. The need of hospitalization in order to conduct these procedures delays even further this diagnosis, which should be concluded by the eighth week of life

Colestase neonatal : atraso no encaminhamento de crianças para diagnóstico diferencial

Objetivo - O tratamento eficaz da atresia de vias biliares extrahepáticas exige que a diferenciação diagnóstica entre colestase neonatal de causa intra e extra-hepática seja realizada antes das primeiras oito semanas de vida. O objetivo do presente estudo foi avaliar a idade dos pacientes com colestase neonatal internados em um hospital geral para diferenciação diagnóstica da icterícia colestática. Métodos - Foram estudadas 49 crianças no Serviço de Pediatria do Hospital de Clínicas de Porto Alegre entre 1984 e 1991. O protocolo para esclarecimento diagnóstico seguido neste hospital inclui realização de cintilografia de vias biliares com Tc-99m DISIDA e posterior biópsia hepática, em cunha ou percutânea dependendo do resultado do teste cintilográfico. Foram comparadas as idades das crianças por ocasião dos procedimentos. Em 26 casos o estudo foi retrospectivo; em 23, prospectivo. Resultados - Os pacientes foram submetidos à cintilografia em média com 77,94 + 42,98 dias de vida. A biópsia hepática foi realizada cerca de 2 semanas após o teste cintilográfico. Apenas 6 pacientes (12,8% dos 47 casos) foram submetidos à biópsia antes das primeiras oito semanas de vida. Não houve diferença quanto à idade na data da cintilografia entre os pacientes estudados retrospectiva e prospectivamente. Conclusões - Ocorre atraso no encaminhamento dos pacientes para o diagnóstico diferencial da colestase neonatal e também na realização dos testes. A necessidade de hospitalizar para a execução dos procedimentos retarda ainda mais a elaboração diagnóstica, que deveria estar concluída antes das primeiras oito semanas de vida.Objective- An efficient treatment of extrahepatic biliary atresia demands that the diagnostic differentiation between intra- and extrahepatic neonatal cholestasis be performed by the eighth week of life. This study aimed at evaluate the age of the patients admitted to a general hospital for differential diagnosis of cholestatic jaundice. Methods- Forty nine children from the Pediatric Service at Hospital de Clínicas, in Porto Alegre, have been studied between 1984 and 1991, according to the protocol for diagnostic elucidation followed by this hospital, which includes biliary tract scintigraphy with Tc-99m DISIDA and, depending on its results, an wedge or percutaneous liver biopsy. The ages of the children have been compared on the occasion of the procedures. Twenty six cases have been studied retrospectively and 23, prospectively. Results- Both the patients with intrahepatic and extrahepatic cholestasis underwent scintigraphy, on average at over eight weeks (age 77.94 + 42.98 days) and the histopathological study of the liver was performed approximately two weeks after scintigraphy. Only six patients (12.8% of the 47 cases) underwent the liver biopsy before the first eighth week of life. Conclusions- A delay was observed in referring patients for differential diagnosis of neonatal cholestasis and the performance of tests. The need of hospitalization in order to conduct these procedures delays even further this diagnosis, which should be concluded by the eighth week of life

Polysplenia syndrome associated to neonatal hepatitis

Objetivo: Relatar o caso de um paciente com colestase neonatal que apresentava concomitantemente síndrome de polisplenia e hepatite neonatal idiopática. Métodos: Estudaram-se aspectos clínicos, bioquímicos, histopatológicos e de diagnóstico por imagem e achados cirúrgicos. Resultados: O paciente, com 36 dias de vida, apresentava hiperbilirrubinemia, com aumento de bilirrubina de reação direta e fosfatase alcalina elevada. Ao exame físico apresentava icterícia e hepatomegalia. Nos exames radiológicos do tórax foram demonstrados situs inversus torácico e dextrocardia. A ecografia abdominal mostrou aumento do volume hepático, principalmente à custa do lobo direito. Havia duas lesões císticas no fígado, com ausência de dilatação de vias biliares intra-hepáticas. Não havia esplenomegalia. A cintilografia de vias biliares não demonstrou excreção do rádio-isótopo para o duodeno. A colangiografia transoperatória, porém, mostrou passagem de contraste para a luz duodenal. Durante a laparotomia foi observada polisplenia, aorta abdominal à direita da veia cava inferior, vesícula biliar localizada no lobo hepático esquerdo, ceco à esquerda e sigmóide à direita. A biópsia em cunha foi compatível com hepatite neonatal idiopática. Conclusão: O achado da síndrome de polisplenia em paciente com colestase neonatal não indica necessariamente a presença concomitante de atresia de vias biliares extra-hepáticas.Objective- To report the unusual association between neonatal hepatitis and polysplenia syndrome. Methods - Clinical, biochemical, histopathological, surgical and image analysis methods were used. Results- The 36 days old patient presented hyperbilirubinemia with increase of direct reacting bilirubin and high alkaline phosphatase. The physical examination evidenced jaundice and hepatomegaly. The chest X-ray showed situs inversus and dextrocardia. Abdominal ultrasonography presented an increase in liver volume, mainly at the right lobe. There were two cystic lesions at the liver with absence of intrahepatic biliary tract dilatation. Absence of splenomegaly. Biliary scintigraphy didn’t show any excretion of radioisotope to the duodenum while transoperative cholangiography presented contrast medium flowing to the duodenum lumen. During laparotomy it was possible to observe polysplenia, abdominal aorta to the right of the lower vena cava, gallbladder at the left lobe of the liver, appendix on the left side of the abdomen and sigmoid colon on the right side. The hepatic wedge biopsy was compatible with idiopathic neonatal hepatitis. Conclusion- The finding of polysplenia syndrome in patients with neonatal cholestasis doesn’t necessarily indicate the recurrent presence of extrahepatic biliary atresia

Histopathological diagnosis of intra- and extrahepatic neonatal cholestasis

The histopathology of the liver is fundamental for the differential diagnosis between intra- and extrahepatic causes of neonatal cholestasis. However, histopathological findings may overlap and there is disagreement among authors concerning those which could discriminate between intra- and extrahepatic cholestasis. Forty-six liver biopsies (35 wedge biopsies and 11 percutaneous biopsies) and one specimen from a postmortem examination, all from patients hospitalized for neonatal cholestasis in the Pediatrics Service of Hospital de Clínicas de Porto Alegre, were prospectively studied using a specially designed histopathological protocol. At least 4 of 5 different stains were used, and 46 hepatic histopathological variables related to the differential diagnosis of neonatal cholestasis were studied. The findings were scored for severity on a scale from 0 to 4. Sections which showed less than 3 portal spaces were excluded from the study. Sections were examined by a pathologist who was unaware of the final diagnosis of each case. Bile tract permeability was defined by scintigraphy of the bile ducts and operative cholangiography The F test and discriminant analysis were used as statistical methods for the study of the hepatic histopathological variables. The chi-square method with Yates correction was used to relate the age of the patients on the date of the histopathological study to the discriminatory variables between intraand extrahepatic cholestasis selected by the discriminant function test. The most valuable hepatic histopathological variables for the discrimination between intra- and extrahepatic cholestasis, in decreasing order of importance, were periportal ductal proliferation, portal ductal proliferation, portal expansion, cholestasis in neoductules, foci of myeloid metaplasia, and portal-portal bridges. The only variable which pointed to the diagnosis of intrahepatic cholestasis was myeloid metaplasia. Due to the small number of patients who were younger than 60 days on the date of the histopathological study (N = 6), no variable discriminated between intra- and extrahepatic cholestasis before the age of 2 months and all of them, except for the portal expansion, were discriminatory after this age. In infants with cholestasis, foci of myeloid metaplasia, whenever present in the liver biopsy, suggested intrahepatic cholestasis. Periportal ductal proliferation, portal ductal proliferation, portal expansion, cholestasis in neoductules, portal cholestasis and portal-portal bridges suggested extrahepatic obstructive cholestasis