Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure

A 65-year-old man was evaluated for a difficult-to-characterize pancreatic head mass in the setting of idiopathic chronic pancreatitis. He had no other relevant medical history and was not taking any anticoagulant or antiplatelet treatment. Endoscopic ultrasonography fine-needle aspiration (EUS-FNA) failed to reveal neoplasm cells. A linear array echoendoscope (Olympus GF-UCT140, Center Valley, PA) was advanced up to the duodenal bulb, from which the head of the pancreas was visualized. After ensuring a vessel-free access to the pancreatic parenchyma, the FNA was performed using a 22G needle (Slimline 22G Handle Needle; Boston Scientific, Marlborough, MA) with a total of 3 passes (Figure 1). Three weeks after this procedure, the patient was admitted for hematemesis preceded by vomiting. On admission, his general physical examination was unremarkable except for jaundice. His blood tests showed no anemia; his platelet count, prothrombin time, amylase, and liver enzymes were within normal range, but his total bilirubin level was elevated (7.4 mg/dL). Upper gastrointestinal endoscopy showed Mallory-Weiss tears, an evident extrinsic compression of the knee, and the second portion of the duodenum, which could not be passed by the endoscope. The investigation by computed tomography and magnetic resonance cholangiopancreatography led to the diagnosis of an 11-cm intramural duodenal hematoma (IDH), leading to both gastric outlet and main biliary duct obstruction (Figure 2). The case was successfully managed with nasogastric decompression and exclusive parenteral feeding. Symptoms improved within 15 days, and cholestasis progressively disappeared.info:eu-repo/semantics/publishedVersio

Revisão Narrativa Sobre a Terapêutica com Agentes Anti-Tumor Necrosis Factor α na Doença Inflamatória Intestinal Durante a Gravidez: Translocação Placentária de Imunoglobulinas e seu Impacto

INTRODUCTION: Inflammatory bowel disease activity is associated with adverse pregnancy outcomes. Anti-tumor necrosis factor α therapy is often required to treat flares and to maintain disease remission. However, there are concerns regarding treatment with these agents during pregnancy, as they actively cross the placental barrier. MATERIAL AND METHODS: Studies regarding anti-tumor necrosis factor α therapy during pregnancy were identified from PubMed from 1958 to January 2018. The reference lists of the selected studies were reviewed to identify complementary publications. RESULTS AND DISCUSSION: Anti-tumor necrosis factor α agents are efficient treatments for moderate-to-severe inflammatory bowel disease and may ensure remission during pregnancy. Although these drugs cross the placenta, they are considered safe for both the mother and the fetus. Furthermore, up-to-date guidelines support therapy continuation during pregnancy aiming for disease control. The same guidelines also consider stopping treatment during the third trimester to limit maternal-fetal drug transfer. However, data shows that this strategy does not completely prevent fetus exposure. In addition, stopping treatment incurs in risk of disease flare and threatens subsequent therapy response. Fetus drug exposure has not showed an association with adverse childhood development. However, as infant drug levels could be detected up to seven months after birth, postponement of live virus vaccination is recommended. CONCLUSION: There should be no disagreement among the medical community as to the need to maintain therapy aiming for disease remission during gestation in inflammatory bowel disease. Anti-tumor necrosis factor α agents are safe for both the mother and the fetus.info:eu-repo/semantics/publishedVersio

Vanek tumor -endo-laparoscopic approach

:Vanek’s tumor was first reported in 1949 as a benign gastrointestinal (GI) submucosal alteration, being more prevalent at the stomach (70%) and ileum (20%). This entity corresponds to 0.1% of all gastric polyps, and its diagnosis is mostly incidental when searching for an upper gastrointestinal bleeding cause. The authors present a case and iconography of a Vanek lesion

Minimally invasive treatment of gastric GIST by endo-laparoscopy

The gastrointestinal stromal tumor,s (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Surgery is the primary therapeutic approach. Objective: To present the results of patients undergoing combined endo-laparoscopic (ELC) approach as a minimally invasive treatment for gastric GIST

An introduction to violence against women as a human rights and public health problem

O objetivo deste artigo é apresentar àqueles(as) que se iniciam no estudo da violência praticada contra as mulheres uma breve contextualização histórica do modo como, gradualmente, este se tornou um tema do campo dos Direitos Humanos e da Saúde Pública. Partimos da Declaração Universal dos Direitos dos Homens para, em seguida, discutirmos sua importância para o campo dos Direitos Humanos e analisarmos a polêmica entre direitos humanos versus direitos das mulheres. Posteriormente, apresentamos as diversas convenções e tratados internacionais de proteção dos direitos das mulheres e sua importância para a conscientização da Saúde Pública, com relação ao fenômeno da violência. Inicialmente abordada como "causas externas" de morbidade e mortalidade, devido à grande incidência e aos elevados prejuízos sociais, econômicos e de saúde (física e psicológica), atualmente a violência é reconhecida como um campo específico e urgente de intervenção sob a perspectiva da Saúde Pública. De modo particular, a violência praticada contra as mulheres é um problema de proporções mundiais, que atinge pessoas de todas as classes sociais, religiões e etnias. Afirmamos que, a partir da inclusão da violência contra as mulheres na arena dos direitos humanos e da Saúde Pública, começaram a ocorrer transformações mais efetivas nas políticas legais de muitos países, como a criação de programas de intervenção e outros suportes. Por fim, apresentamos a situação do Brasil com relação à igualdade de gênero.The aim of this paper is to show to those who are beginning to study the subject of violence against women a brief historical overview of the way it gradually became a theme of the fields of Human Rights and Public Health. We start with the Universal Declaration of Human Rights to discuss its importance for the field of Human Rights and to analyze the polemic between human rights versus women's rights. After that, we present the international treaties and conventions that protect women's rights and their importance to raise the awareness of the Public Health field about violence. Initially seen as "external causes" of morbidity and mortality, because of its high incidence and several social, economic and health (physical and psychological) damages, nowadays violence is seen as a specific domain of the Public Health field that needs urgent intervention. In particular, violence against women is a global problem that reaches people of all social classes, religions and ethnic groups. We claim that, since the inclusion of violence against women in the fields of Human Rights and Public Health, more effective transformations in the legal policies of several countries have begun to occur, like the creation of interventional programs and other supports. At the end, we show Brazil's position about gender equality.info:eu-repo/semantics/publishedVersio