Síndrome colestática devido à compressão linfonodal decorrente de câncer de próstata metastático – relato de caso / Cholestatic syndrome due to lymph node compression from metastatic prostate cancer - case report

Objetivo: relatar e discutir um caso de síndrome colestática por compressão linfonodal decorrente de câncer de próstata metastático.Relato do caso: JPS, masc., 74 anos, portador de hipertensão arterial sistêmica e dislipidemia, foi encaminhado para avaliação de hepatomegalia e encontrava-se em tratamento de adenocarcinoma de próstata.Discussão: O câncer de próstata metastático (CPM) pode se apresentar com uma variedade de sintomas inespecíficos ou relacionados ao sítio de instalação metastática.Conclusão: colestase devido à linfodomegalia por metástase é incomum, mas deve ser considerada no diagnóstico diferencial

2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

Cesarean section by maternal request

ABSTRACT Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks

Ciąża bliźniacza przebiegająca w postaci zaśniadu groniastego współwystępującego z żywym płodem: rozpoznanie, postępowanie oraz obserwacja po zakończeniu ciąży

Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin molar pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postmolar follow-up.Zaśniad groniasty stanowi łagodną postać ciążowej choroby trofoblastycznej (gestational trophoblastic disease, GTD)(1). W Brazylii ciążowa choroba trofoblastyczna stwierdzana jest 5–10 razy częściej(2) niż w Stanach Zjednoczonych i Europie(3,4). Zaśniad groniasty powstaje w wyniku nieprawidłowego zapłodnienia komórki jajowej i może przybierać dwie formy: zaśniadu groniastego całkowitego lub zaśniadu groniastego częściowego(1). Z klinicznego punktu widzenia taka reprodukcja materiału genetycznego może prowadzić do rozwinięcia się ciążowej neoplazji trofoblastu, która bez wdrożenia właściwego leczenia może skutkować śmiercią kobiety(1–4). Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-7

Tratamento da síndrome do intestino irritável pós-infecciosa e da síndrome do intestino irritável não-infecciosa com mesalazina

Submitted by Luciana Ferreira ([email protected]) on 2019-02-05T13:12:18Z No. of bitstreams: 2 Artigo - Mauro Bafutto - 2011.pdf: 321747 bytes, checksum: 37c2868d814257c86a2a396d8bac6d6c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira ([email protected]) on 2019-02-06T11:14:44Z (GMT) No. of bitstreams: 2 Artigo - Mauro Bafutto - 2011.pdf: 321747 bytes, checksum: 37c2868d814257c86a2a396d8bac6d6c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2019-02-06T11:14:44Z (GMT). No. of bitstreams: 2 Artigo - Mauro Bafutto - 2011.pdf: 321747 bytes, checksum: 37c2868d814257c86a2a396d8bac6d6c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-03Contexto - Estudos recentes sustentam a hipótese que a síndrome do intestino irritável pós-infecciosa e alguns pacientes com síndrome do intestino irritável mostram sinais menores de inflamação persistente da mucosa. A mesalazina tem propriedades anti-inflamatórias intestinais, incluindo a inibição da ciclooxigenase e das prostaglandinas. Os efeitos da mesalazina na síndrome do intestino irritável pós-infecciosa e em pacientes com síndrome do intestino irritável não-infecciosa ainda são desconhecidos. Objetivo - Observar os efeitos da mesalazina em pacientes com síndrome do intestino irritável pós-infecciosa e síndrome do intestino irritável com diarréia não-infecciosa. Métodos - Com base nos critérios de Roma III, 61 pacientes síndrome do intestino irritável acompanhado de diarréia (18 anos ou mais de idade) foram incluídos na avaliação. Os pacientes foram divididos em dois grupos: grupo síndrome do intestino irritável pós-infecciosa, com 18 pacientes medicados com mesalazina 800 mg 3 vezes ao dia por 30 dias; grupo síndrome do intestino irritável não-infecciosa, com 43 pacientes medicados com mesalazina 800 mg 3 vezes ao dia por 30 dias. Avaliações dos sintomas no início e após o tratamento foram realizadas por meio de uma escala Likert de 4 pontos, incluindo a frequência das evacuações, forma e consistência das fezes (Bristol Stool Scale), dor e distensão abdominal (pontuação máxima: 16; pontuação mínima: 4). Resultados – O grupo síndrome do intestino irritável pós-infecciosa apresentou redução estatisticamente significante do escore total de sintomas (P<0,0001). A frequência de evacuações foi significativamente reduzida (P<0,0001) e a consistência das fezes melhoraram (P<0,0001). Dor abdominal (P<0,0001) e distensão abdominal foram significativamente reduzidas (P<0,0001). O grupo síndrome do intestino irritável não-infecciosa apresentou redução estatisticamente significante do escore total de sintomas (P<0,0001). Além disso, a frequência de fezes foi significativamente reduzida (P<0,0001) e a consistência das fezes melhoraram (P<0,0001). Dor abdominal (P<0,0001) e distensão abdominal foram significativamente reduzidas (P<0,0001). Não houve diferença estatística entre o grupo síndrome do intestino irritável pós-infecciosa e o grupo síndrome do intestino irritável não-infecciosa sobre os resultados da pontuação total dos sintomas em 30 dias de terapia com mesalazina 800 mg 3 vezes ao dia (P= 0,13). Conclusão - O uso de mesalazina reduziu os principais sintomas da síndrome do intestino irritável pós-infecciosa e da síndrome do intestino irritável com diarréia não-infecciosa.Context - Recent studies support the hypothesis that postinfectious irritable bowel syndrome and some irritable bowel syndrome patients display persistent signs of minor mucosal inflammation. Mesalazine has intestinal anti-inflammatory properties including cyclooxygenase and prostaglandin inhibition. The effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome patients are still unknown. Objective - To observe the effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients. Methods - Based on Rome III criteria, 61 irritable bowel syndrome with diarrhea patients (18 years old or more) were included in the evaluation. Patients were divided into two groups: postinfectious irritable bowel syndrome group, with 18 patients medicated with mesalazine 800 mg 3 times a day for 30 days; noninfective irritable bowel syndrome group, with 43 patients medicated with mesalazine 800 mg 3 times a day for 30 days. Symptom evaluations at baseline and after treatment were performed by means of a four-point Likert scale including stool frequency, stool form and consistency (Bristol Stool Scale), abdominal pain and distension (maximum score: 16; minimum score: 4). Results - Postinfectious irritable bowel syndrome group presented a statistically significant reduction of the total symptom score (P<0.0001). The stool frequency was significantly reduced (P<0.0001), and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distension were significantly reduced (P<0.0001). Noninfective irritable bowel syndrome group presented a statistically significant reduction of total symptom score (P<0.0001). Also, the stool frequency was significantly reduced (P<0.0001) and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distention were significantly reduced (P<0.0001). There was no statistical difference between postinfectious irritable bowel syndrome group and noninfective irritable bowel syndrome group on total symptom score results at 30th day of therapy with mesalazine 800 mg 3 times a day. (P = 0.13). Conclusion - Mesalazine reduced key symptoms of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients