Ganglioneuroma da Supra-renal – relato de caso clínico

INTRODUÇÃO Os ganglioneuromas da supra-renal são tumores raros, benignos, bem diferenciados e têm origem na crista neural. A maioria dos doentes com ganglioneuroma da supra-renal são assintomáticos, e grande parte destes tumores são não secretores. Geralmente, são encontrados acidentalmente em exames de imagem abdominal por outro motivo. CASO CLÍNICO Sexo feminino, 53 anos, com antecedentes de hipertensão arterial diagnosticada aos 30 anos, dislipidémia, patologia depressiva e histerectomia por prolapso uterino. Medicada habitualmente com espironolactona, cloreto de potássio, atorvastatina, omeprazol, fluoxetina e lorazepam. Antecedentes de internamentos de repetição em serviço de Medicina Interna por hipocaliémia recorrente. Referenciada à consulta de Endocrinologia por suspeita de hiperaldosteronismo primário. Apresentava nódulo na supra-renal diagnosticado em contexto de estudo da hipertensão arterial e hipocaliémia. Clínica de astenia, anorexia, cãimbras e dores musculares com alguns meses de evolução. Sem alterações relevantes ao exame objectivo. A TC das supra-renais revelava “supra-renal esquerda com nódulo hipodenso de 3 cm, eventual adenoma”. A RM abdomino-pélvica mostrou: “supra-renal esquerda com massa quística complexa, com parede espessa (3-5mm de espessura parietal), onde se identifica um nódulo mural com ~11x7mm, questionando-se a possibilidade de degenerescência quística tumoral/pseudoquisto, sendo de ponderar a sua exérese cirúrgica.” O estudo funcional do nódulo foi normal. Foi submetida a suprarrenalectomia esquerda por via laparoscópica. O exame histológico revelou um ganglioneuroma. Foi referenciada a consulta de Nefrologia para investigação da hipocaliémia, tendo sido excluída doença intersticial renal com perda de potássio. Actualmente, seguida em consulta de Psiquiatria por provável síndrome de Munchausen, por suspeita de indução crónica de vómito. CONCLUSÃO Apresentamos este caso pela raridade da entidade clínica. São geralmente tumores não secretores e a maioria dos doentes estão assintomáticos na altura do diagnóstico, tal como no caso apresentado. O prognóstico dos doentes submetidos a ressecção completa do tumor é excelente

Ganglioneuroma of the Adrenal Gland - a case report

Introduction: The adrenal ganglioneuroma are rare, benign and well differentiated tumors that arise from neural crest tissue. Most patients with adrenal ganglioneuroma are asymptomatic, and most of these are non-secreting tumors. They are usually found incidentally on abdominal imaging study for another reason. Case: A 53-year-old female, with a history of hypertension diagnosed at age 30, dyslipidaemia, depressive disorder and hysterectomy for uterine prolapse. Medicated with spironolactone, potassium, atorvastatin, omeprazole, fluoxetine and lorazepam. History of repeat hospitalizations in the Internal Medicine Service for recurrent hypokalaemia. During the investigation of hypertension and hypokalaemia, a hypodense nodule in the left adrenal gland was detected on abdominal CT. She was referred to our service of Endocrinology due to suspected primary aldosteronism. She presented with asthenia, anorexia, cramps and muscle aches with a few months of evolution. Physical examination demonstrated no significant finding. Adrenal CT showed a left adrenal with hypodense nodule with 3 cm. Abdominal-pelvic MRI revealed a left adrenal with complex cystic mass with thick walls, where it identifies a mural nodule with 11×7 mm, questioning the possibility of tumor or pseudocyst cystic degeneration, and of considering their surgical excision. Endocrine tests were normal. Left adrenalectomy was performed by laparoscopy. The histological diagnosis was adrenal ganglioneuroma. Nephrology consultation for investigation of hypokalemia excluded renal interstitial disease with potassium loss. Currently, she attends Psychiatric consultation on suspicion Munchausen syndrome. Conclusion: We present this case due to the rarity of the clinical entity and the clinical presentation, which initially pointed us to another diagnosis. Ganglioneuromas are generally non-secreting tumors, and most patients are asymptomatic at diagnosis, as in the case presented. The prognosis of patients who underwent complete tumor resection is excellent

A NEW POSSIBILITY FOR SURVEILLANCE: DO WE IDENTIFY ALL CASES OF LEPTOSPIROSIS?

SUMMARY Leptospirosis is a febrile disease with a typically underestimated global incidence, especially in regions where dengue is endemic. Therefore, it is difficult to accurately determine the number of leptospirosis cases in these areas, which contributes to significant under-reporting this disease. In this study, we estimated the number of possible leptospirosis cases among dengue-like cases that were reported during 2008, 2010, and 2012 in the city of Fortaleza, northeast Brazil. Patients were evaluated for dengue and leptospirosis using immunoenzymatic tests for IgM antibodies that were specific to each pathogen. Among the suspected cases of dengue that resulted as negative in laboratory tests, 10.8% (2008), 19.2% (2010), and 30.8% (2012) were confirmed to be leptospirosis. Considering the cases reported by the surveillance authority as dengue that were subsequently discarded based on the laboratory test results, we estimate that the number of actual leptospirosis cases may be 26 to 49 times higher than those diagnosed and reported by the Health Services. Furthermore, we believe that approximately 20% of dengue-like cases may be leptospirosis cases in areas where the two diseases are endemic

Inelastic Black Hole Scattering from Charged Scalar Amplitudes

We explain how the lowest-order classical gravitational radiation produced during the inelastic scattering of two Schwarzschild black holes in General Relativity can be obtained from a tree scattering amplitude in gauge theory coupled to scalar fields. The gauge calculation is related to gravity through the double copy. We remove unwanted scalar forces which can occur in the double copy by introducing a massless scalar in the gauge theory, which is treated as a ghost in the link to gravity. We hope these methods are a step towards a direct application of the double copy at higher orders in classical perturbation theory, with the potential to greatly streamline gravity calculations for phenomenological applications.Comment: 28 pages, 6 figure

Nutritional status of pre-school children from low income families

<p>Abstract</p> <p>Background</p> <p>We evaluated growth and nutritional status of preschool children between 2 and 6 years old from low income families from 14 daycare centers.</p> <p>Methods</p> <p>Cross-sectional study with 1544 children from daycare centers of Santo Andre, Brazil. Body weight (W), height (H) and body mass index (BMI) were classified according to the 2000 National Center for Health Statistics (CDC/NCHS). Cutoff points for nutritional disorders: -2 z scores and 2.5 and 10 percentiles for malnutrition risk, 85 to 95 percentile for overweight and above BMI 95 percentile for obesity. Stepwise Forward Regression method was used including age, gender, birth weight, breastfeeding duration, age of mother at birth and period of time they attended the daycare center.</p> <p>Results</p> <p>Children presented mean z scores of H, W and BMI above the median of the CDC/NCHS reference. Girls were taller and heavier than boys, while we observed similar BMI between both genders. The z scores tended to rise with age. A Pearson Coefficient of Correlation of 0.89 for W, 0.93 for H and 0.95 for BMI was documented indicating positive association of age with weight, height and BMI. The frequency of children below -2 z scores was lower than expected: 1.5% for W, 1.75% for H and 0% for BMI, which suggests that there were no malnourished children. The other extremity of the distribution evidenced prevalence of overweight and obesity of 16.8% and 10.8%, respectively.</p> <p>Conclusion</p> <p>Low income preschool children are in an advanced stage of nutritional transition with a high prevalence of overweight.</p