Degos disease – malignant atrophic papulosis or cutaneointestinal lethal syndrome: rarity of the disease

Background: Degos disease is a very rare syndrome with a rare type of multisystem vasculopathy of unknown cause that affects the skin, gastrointestinal tract, and central nervous system. Other organs such as the kidneys, lungs, pleura, liver, heart, and eyes, can also be involved. Objective: To highlight the incidence of Degos disease with regard to age and sex, discuss the necessity of its accurate and early diagnosis, and demonstrate the most current techniques for its diagnosis; to discuss whether early therapeutic intervention can impact patient prognosis; and to present a literature review about this disease. Design: With a retrospective, observational, nonrandomized trial, we described the evolution of the different forms of Degos disease and referenced the literature. Data sources Research on rare documented cases in the literature, including two cases of potentially lethal form of the disease involving the skin and gastrointestinal system and, possibly, the lungs, kidneys, and central nervous system. A case of the benign form of the disease involving the skin was observed by the authors. Main outcome measures Differences between outcomes in patients with the cutaneointestinal form and skin-only form of the disease. There was one fatal outcome. We reviewed possible new approaches to diagnosis and treatment. Results: The study demonstrated the rapid evolution of the aggressive and malignant form of the disease. It also described newly accessible Phase I diagnostic tools being currently researched as well as new therapeutic approaches. Limitation The rarity of the disease, with only eleven cases throughout the literature. Conclusion: The gastrointestinal form of Degos disease can be lethal. Its vascular etiology has finally been confirmed; however, new and more accurate early diagnostic modalities need to be developed. There are new therapeutic possibilities, but the studies of them are still in the early stages and have not yet shown the full effectiveness of these new therapies

Bañado de sonrisas : Del Bermejo al Pilcomayo

Introducción: Este programa busca continuar con el trabajo extensionista que se viene realizando desde hace 20 años en la Provincia de Formosa. Se pretende revertir una creciente y reiterada problemática, la pérdida prematura de las piezas dentarias en niños y adolescentes. Esto ocurre principalmente por falta de profesionales e instituciones sanitarias cercanas y la imposibilidad geográfica y económica de acercarse a un Centro de Salud. La Facultad de Odontología es contactada todos los años para intervenir en dicha problemática, aumentando el número de escuelas visitadas año tras año.Por lo antes mencionado, esta actividad pretende seguir realizando tareas de promoción y prevención y tratamiento de enfermedades bucales, abordando en forma integral a más de 800 niños, niñas y adolescentes, mediante el empleo de técnicas no invasivas, creadas para la atención en terreno. Objetivos: Brindar Atención Primaria de la Salud, con participación comunitaria y fuerte contenido preventivo que garantice un impacto en la salud en las poblaciones del Noroeste Formoseño.Concientizar a los destinatarios sobre los riesgos que ocasionan las patologías bucales.Capacitar a estudiantes de odontología en Atención Primaria de Salud y Técnica Restaurativa Atraumática, aplicando lo aprendido en terrenos desfavorables optimizando el recurso.Valorar la aplicación de fluoruros como herramienta preventiva de excelencia.Lograr cambios de hábito en niños y adolescentes enseñándoles técnicas de cepillado y uso de hilo dental.Generar espacios de reflexión sobre la importancia de una correcta alimentación.Alcanzar la sostenibilidad del programa a través del tiempo.Facultad de Odontologí

Bañado de sonrisas : Del Bermejo al Pilcomayo

Este programa busca continuar con el trabajo extensionista desarrollado desde hace mas de 20 años en la provincia de Formosa. Se pretende revertir una creciente y reiterada problemática que es la pérdida prematura de las piezas dentarias en niños y adolescentes. Esto ocurre principalmente por falta de profesionales e instituciones sanitarias cercanas y la imposibilidad geográfica y económica de acercarse a centros de salud. La Facultad de Odontología es contactada todos los años para intervenir en dicha problemática, aumentando el número de escuelas visitadas año tras año. Por lo antes mencionado, esta actividad pretende seguir realizando tareas de promoción y prevención y tratamiento de enfermedades bucales, abordando en forma integral a niños, niñas y adolescentes, mediante el empleo de técnicas no invasivas, creadas para la atención en terreno.Facultad de Odontologí

The incidence of nontraumatic acute pancreatitis in acute spinal cord injury

A pancreatite é o resultado da atividade corrosiva das enzimas digestivas pancreáticas e, independente dos vários agentes etiológicos e dos mecanismos etiopatogênicos, tem como resultado a ativação enzimática intra-parenquimatosa, a destruição tecidual e a necrose isquêmica. Trata-se de uma afecção, grave, com incidência aumentada em vítimas de traumatismo raquimedular. Nesses doentes, a suspeita clínica de pancreatite pode ser difícil, pois os sinais e sintomas podem estar diminuídos ou ausentes em decorrência do déficit sensorial esplâncnico. Avaliaram-se, prospectivamente, 78 doentes com traumatismo raquimedular internados no IOT-HCFMUSP, dosando-se os níveis séricos das enzimas amilase e lipase em 3 períodos de tempo pré-determinados, entre os dias de 1 a 3, de 10 a 12 e de 15 a 20 após o traumatismo. A incidência de pancreatite aguda foi maior nos pacientes com traumatismo raquimedular ASIA A e que apresentaram íleo adinâmicoAcute pancreatitis is a result of corrosive activity of pancreatic digestive enzymes, and many etiologic agents trigger acute pancreatitis by a variety of different mechanisms, but the ultimate result is a tissue destruction. The incidence in spinal cord injury patients is higher than the normal population. The clinical diagnosis of acute pancreatitis in spinal cord injury patients is hampered by a lower or lost visceral sensitivity, as a result in a necessity of laboratory investigations to confirm diagnosis. A prospective study with 78 acute spinal cord injury patients of The Clinical Hospital of the College of Medicine of University of São Paulo is performed. The incidence of pancreatitis is larger in patients of spinal cord injury ASIA A and with ileus paralyti

PPH AND BIOLOGICAL GLUE IN PATIENTS WITH HIGH RISK OF BLEEDING IN STAPLED HEMORRHOIDOPEXY

ABSTRACT Background: Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue. Aim: Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue. Methods: Between 2005 and 2015, 22 patients were analyzed, in a retrospective cohort study. Results: From 22 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue, only one (4.5%) presented bleeding in the surgical postoperative. Patients do not have any other complications and pain in the postoperative period. The median (IQR) operation duration was 55 (12) min and the median (IQR) length of hospital stay after surgery was 3 (2) days. Conclusion: Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue presented very low rates of bleeding in the postoperative period

A modified laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 and metabolic syndrome in obesity

BACKGROUND: Ghrelin is a gastrointestinal peptide hormone (a 28-amino acid peptide) produced primarily by X/A cells in the oxyntic glands of the stomach fundus and cells lining the duodenum cavern. It suppresses insulin secretion and action and commands a significant role in regulating food intake. The aim of the present study was to show that modified laparoscopic sleeve gastrectomy (MLSG), in which a significant part of the gastric fundus and body of the stomach is removed up to 1 inch from the pylorus vein, may contribute to decreasing circulating ghrelin levels. METHODS: A study population consisting of 150 individuals was monitored after undergoing a MLSG, with individuals chosen based on a documented history of diabetes mellitus type 2 and metabolic syndrome, clinical results determining a body mass index (BMI) of 35 to 60 kg/m(2), peptide C level greater than 1, negative anti-glutamic acid decarboxylase, negative anti-insulin, and confirmed stability of drug/insulin treatment and glycosylated hemoglobin greater than 6.5% for at least 24 and 3 months, respectively, before enrollment. RESULTS: Twenty-four months after surgery, 150 patients (86.6%) presented with normal glycemic levels between 77 and 99 mg/dL. All patients improved average serum insulin levels by 9 mU/L and average glycosylated hemoglobin levels by 5.1% (normal range, 4%-6%). All patients tested negative for Helicobacter pylori and stopped using insulin, with 3 patients prescribed twice-daily use of an oral hypoglycemiant. In 14% of cases, patients experienced partial hair loss with low serum zinc levels and were prescribed oral zinc reposition and topical hair stimulants. The average weight loss recorded was 44.6% for patients with a BMI less than 45 kg/m(2) and 58% for patients with a BMI greater than 50 kg/m(2). CONCLUSIONS: The MLSG is a safe procedure with a low morbidity rate (2.7%) (4 cases of fistula and 2 of bleeding) and no surgical mortality in this study. This surgery can promote control of diabetes mellitus type 2 and aid the treatment of exogenous overweight and morbidly obese individuals. The results of this study show that only through resection of the ghrelin-producing gastric area can most obesity cases and diabetes type II conditions be reverted to nonobese and controlled diabetes. (c) 2012 Elsevier Inc. All rights reserved