TRATAMENTO ENDOVASCULAR DE SÍNDROME DA VEIA CAVA SUPERIOR POR DISPOSITIVO DE ACESSO VENOSO CENTRAL TOTALMENTE IMPLANTÁVEL — CASO CLÍNICO

Introdução: O síndrome da Veia Cava Superior (sVCS) benigno é raro e pode estar relacionado com um dispositivo de acesso venoso central totalmente implantável (DAVCTI). Nos últimos 20 anos, a dilatação com colocação de stent por via percutânea endovascular tem surgido como uma opção viável para a terapêutica do sVCS. Caso clínico: Apresentamos o caso de uma mulher de 42 anos com o diagnóstico de linfoma de Hodgkin clássico que desenvolveu sVCS um ano após a colocação de DAVCTI e em que, após falência da terapêutica conservadora, se colocou uma endoprótese auto-expansível pelo DAVCTI com bom resultado imagiológico e clínico. Conclusão: O tratamento endovascular do sVCS usando o lúmen do DAVCTI é seguro e pode ser considerada terapêutica de primeira linha

PEDIATRIC PRIMARY HYPERPARATHYROIDISM: A RARE CAUSE OF NEPHROLITHIASIS

Introdução: O hiperparatiroidismo primário é uma doença rara na idade pediátrica e define-se como uma alteração primá-ria das glândulas paratiroideias, que condiciona uma produção excessiva de hormona paratiroideia. Caso Clínico: Adolescente do sexo masculino com doze anos de idade admitido na Urgência pediátrica por lombalgia tipo cólica e disúria. A ecografia renal evidenciou litíase renal. A investigação laboratorial realizada revelou hipercalcémia, ele-vação sérica da hormona paratiroideia e hipercalciúria. Estabe-lecido o diagnóstico de hiperparatiroidismo primário, realizou ecografia cervical e cintigrafia das glândulas tiroideias e para-tiroideias que foi sugestiva de adenoma da paratiroideia infe-rior direita. Submetido a paratiroidectomia inferior direita com normalização dos valores da calcémia e da hormona paratiroi-deia pós-cirurgia. O exame histológico revelou hiperplasia das células principais. O estudo genético realizado foi negativo.Conclusão: O hiperparatiroidismo primário deve ser con-siderado no diagnóstico diferencial de litíase renal, de forma a permitir uma intervenção precoce determinante na prevenção de lesão de órgão-alvo.Introduction: Primary hyperparathyroidism is a rare disease in the pediatric age group and a rare cause of nephrolithiasis. It results from an excessive production of the parathyroid hormone due to abnormalities within the parathyroid glands.Case report: The patient was a twelve-year-old male admitted in the paediatrics emergency department with intermitent flank pain and dysuria. An abdominal ultrassound identified nephrolithiasis. Laboratorial tests showed hypercalcemia, an increased serum level of parathyroid hormone and hypercalciuria. A primary hyperparathyroidism was diagnosed and the ultrassound plus scintigraphy of both thyroid and parathyroid glands revealed a right lower parathyroid adenoma. A right lower parathyroidectomy was performed with regularization of the calcium and parathyroid hormone levels. The histopathology revealed main cells hyperplasia and genetic tests were negative.Conclusion: Primary hyperparathyroidism should be considered in the differential diagnosis of nephrolithiasis to allow an early intervention and prevent organ damage.info:eu-repo/semantics/publishedVersio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ostomy metastasis after pull endoscopic gastrostomy: a unique favorable outcome

Head and neck cancer (HNC) patients tend to develop dysphagia. In order to preserve the nutritional support, many undergo endoscopic gastrostomy (PEG). In HNC patients, ostomy metastasis is considered a rare complication of PEG, but there are no reports of successful treatment of these metastatic cancers. We report the case of a 65 years old pharyngeal/laryngeal cancer patient who underwent a PEG before the neck surgery. He was considered to be cured, resumed oral intake and the PEG tube was removed. Ten months after, he returned with a metastasis at the ostomy site. A block resection of the stomach and abdominal wall was performed. Two years after the abdominal surgery, he is free of disease. Although usually considered a rare complication of the endoscopic gastrostomy, ostomy metastasis may be more frequent than usually considered and the present case report demonstrates that these patients may have a favourable outcome.info:eu-repo/semantics/publishedVersio

TUMOR DO ESTROMA GASTROINTESTINAL

We report a case of an 87-year-old female patient, admitted to our emergency room with an acute abdomen. Exploratory laparotomy revealed a perforated jejunal lesion, histopathological examination was consistent with a gastrointestinal stromal tumor (GIST). GISTs are rare tumors with nonspecific and variable clinical symptoms. An initial clinical presentation as acute abdomen due to perforation, is very rare.Apresentação do caso clínico de uma doente de 87 anos, admitida no serviço de urgência, por quadro de abdómen agudo. A laparotomia de urgência revelou uma lesão jejunal perfurada, tendo-se confirmado histologicamente, tratar-se de um tumor do estroma gastrointestinal (GIST). Os GIST são tumores raros, cuja forma de apresentação é muito variada e inespecífica. Abdómen agudo por perfuração é uma manifestação muito rara, neste tipo de tumores