THORACIC TRAUMA PROFILE OF ATTENDED VICTIMS AT HOSPITAL UNIVERSITÁRIO EVANGÉLICO DE CURITIBA (HUEC)

Introdução: O trauma torácico cursa frequentemente com alterações na dinâmica respiratória e circulatória. A maioria dos traumas torácicos é tratada com drenagem pleural e somente 15-30% necessitarão de toracotomia. Objetivo: Analisar o perfil dos pacientes vítimas de trauma torácico. Metodologia: Analisados 98 prontuários entre Janeiro e Dezembro de 2011, com acometimento torácico que necessitou de drenagem pleural para seu tratamento. Resultados: Oitenta e dois pacientes eram homens e 16 mulheres. A idade média de 36,9 ± 16 anos (variando entre 9 e 83 anos). Quarenta e três (43,8%) foram vítimas de trauma penetrante e 55 (56,2%) de trauma fechado. Quinze pacientes apresentaram hemotórax, 23 pneumotórax e 55 hemopneumotórax. Sessenta e oito pacientes (69,4%) sofreram lesões associadas ao trauma torácico. A permanência com dreno foi de 7 ± 6,2 dias. O volume drenado imediatamente foi 401 mL (variando entre 50 e 1050 ml). Em 12 casos foi realizada toracotomia. Setenta (71,4%) pacientes foram submetidos à antibioticoterapia, por 4,6 ± 6,9 dias. Vinte e sete receberam cuidados em unidade de terapia intensiva, por 10,3 ± 7,9 dias. O tempo médio de internamento foi 9,3 ± 8,4 dias (variando entre 1 e 48 dias). Trinta e um (31,6%) pacientes apresentaram complicações e 17 (17,3%) foram a óbito. Conclusão: Homens com idade entre 15 e 29 anos foram os mais acometidos, submetidos à drenagem pleural por trauma fechado, mais frequentemente associado a hemopneumotórax. A baixa incidência de toracotomia neste estudo confirma a drenagem como tratamento preferencial dos traumas torácicos em nosso meio.Introduction: Thoracic trauma demands special attention because of the changes in respiratory and cardiac dynamics. Most thoracic traumas are treated with chest tubes, only 15-30% require thoracotomy. Objective: To analyze the victims’ profiles of thoracic trauma. Materials and methods: Analysis of 98 medical records treated in a trauma service from January to December 2011, with thoracic involvement that required pleural drainage. Results: Eighty two patients were male and 16 were female. The mean age was 36,9 ± 16 years (from 9 to 83 years). Forty three (43,8%) were victims of penetrating trauma e 55 (56,2%) of blunt trauma. Fifteen patients had hemothorax, 23 pneumothorax and 55 hemopneumothorax. Sixty eight patients (69,4%) suffered associated lesions. The average length with the drain was 7 ± 6,2 days. The mean volume drained immediately was 401 mL (from 50 to 1050 mL). In 12 cases thoracotomy was performed. Seventy patients (71,4%) used antibiotic for an average of 4,6 ± 6,9 days. Twenty seven patients remained in intensive care unit, for an average of 10,3 ± 7,9 days. The mean time of hospitalization was 9,3 ± 8,4 days (from 1 to 48 days). Thirty one patients (31,6%) presented complications and 17 (17,3%) died. Conclusions: Thoracic trauma was more incident in men with age between 15 e 29 years, most frequently blunt trauma victims with hemopneumothorax. The incidence of thoracotomy is this study confirms pleural drainage as the first choice treatment for most of patients in our experience

Congenital juvenile granulosa cell tumor of the testis: Case report and literature review

Juvenile granulosa cell tumor (JGCT) is a very rarely diagnosed benign tumor, accounting for 1.2% of all prepubertal testicular tumors. A full-term healthy neonate was diagnosed with a painless left scrotal mass. During evaluation it was identified to have about two times the volume of the contralateral testis, presenting a firm consistency, not as hard as the consistency of a prenatal testicular torsion. Doppler ultrasound detected a multicystic left testicular mass, with normal blood flow, but failed in detecting normal-appearing testis. Human chorionic gonadotropin (?-HCG) and serum alpha-fetoprotein (AFP) were normal. Inguinal approach was performed, section of the lesion was sent to frozen biopsy and excluded yolk sac tumor, and however the impossibility of detecting normal testis tissue indicated orchiectomy with high ligation of the spermatic cord. Histological evaluation demonstrated gray testicular parenchyma with multicystic aspect fulfilled with yellow fluid. The usual clinical presentation of JGCT is a painless scrotal mass, radiological imaging demonstrates a multicystic tumor. Tumoral markers levels are normal and the standard treatment is the inguinal orchiectomy

Xanthogranulomatous pyelonephritis in pediatric patients: A case report and literature review

Xanthogranulomatous pyelonephritis (XGPN) is a rare and severe variation of chronic pyelonephritis characterized by suppurative destruction of renal parenchyma and its substitution with chronic inflammatory infiltrate. Male, 8 years old, admitted to the pediatric urology service at 7 years of age, with bladder and renal lithiasis. First symptoms started when he was 2 years old but presented no relapse until he turned 7 years old. During two years he had recurrence of renal lithiasis and underwent multiple surgical procedures. He remained asymptomatic for a short period of time and when presented fever and urinary symptoms again and underwent CT scanning that demonstrated left kidney enlargement associated with calculi and air bubbles in its interior, suggesting xanthogranulomatous pyelonephritis. Uretherostomy was performed and the patient had good clinical improvement. Renal exclusion was documented through scintigraphy and total left nephrectomy was performed, with a large amount of pus drained. Histopathology confirmed XGPN diagnosis. One year after surgery, there has been no recurrent renal lithiasis or urinary tract infection. Despite being a rare condition in children, XGPN has great importance as it can be often confused with pediatric renal tumours. Early diagnosis is important in order to promote better survival and clinical outcomes

Estágio voluntário em pronto socorro: instrumento para a formação médica de qualidade

OBJETIVO: Analisar a influência do estágio voluntário em Medicina no Pronto Socorro do Hospital do Trabalhador (PS-HT) na escolha da especialidade médica e sua importância na formação acadêmica. MÉTODOS: Análise do questionário aplicado a médicos e estudantes que estagiaram no Pronto Socorro por 500 horas ou mais, no período de março de 2000 a março de 2012. RESULTADOS: Dos 765 acadêmicos que realizaram mais de 500 horas de atividades práticas no PS-HT, 390 responderam ao questionário - 37,9% com inclinação para especialidade cirúrgica e 24,1% para clínica. O estágio foi determinante na escolha da carreira em 82,3% dos casos, sendo em 83,8% uma influência positiva. Quanto ao incremento das relações interpessoais, 61% dos participantes deu nota e" oito para o relacionamento com outros profissionais da área da saúde, por 71% para o relacionamento com colegas e por 63% no relacionamento com pacientes. O estágio possibilitou aumento da autoconfiança para 92% dos entrevistados e 75% afirmaram incremento no conhecimento técnico. O treinamento foi considerado útil e necessário para a formação acadêmica por 80% dos participantes. CONCLUSÃO: A contribuição do estágio em PS é inegável para a formação médica de qualidade e, na maioria das vezes, uma influência para a escolha da especialidade médica. As diversas situações a que os acadêmicos se deparam os fazem desenvolver inteligências em diversas áreas que não a puramente técnica e aplicada, o que se reflete na prática médica, independente da área ou especialidade

De Garengeot hernia: Case report and review

Introduction: Rene De Garengeot, a French surgeon, was the first to describe the presence of the appendix inside a femoral hernia sac in 1731. It is a rare entity that has fewer than 100 cases reported in literature. Presentation of case: An 86 years-old male patient, comes to Emergency Department complaining of painful bulging in the right inguinal region, associated with local inflammatory signs. He was initially diagnosed as incarcerated femoral hernia and underwent emergency open surgery. Inguinotomy was performed and after hernia sac dissection it was possible to observe the presence of the appendix incarcerated in its interior, without clinical signs of appendicitis. Surgeons performed appendectomy and inguinal repair of the femoral hernia with placement of a polypropylene mesh. Discussion: De Garengeot hernia is a rare entity that requires early treatment in order to avoid possible complications. When facing a patient with incarcerated hernia emergency surgery must be indicated even if it is not possible to determine the contents of the hernia. Conclusion: This paper presents a case report of a De Garengeot hernia patient who presented a good evolution after surgery

Endoanal pilonidal sinus: case report and literature review

AbstractPilonidal sinus is a term first used by Hodges in 1880 to describe granulomatous lesions containing hairs in its interior. The presence of endoanal pilonidal sinus is rare and only nine cases have been reported in medical literature. This article describes a male, 42 years, initially submitted to fistulotomy with seton placement that four years later evolved with complaints of anal purulent discharge associated with painful anal groin. During the first evaluation a small endoanal tumor was found. It was located in posterolateral anus position and contained hair in its interior, without purulent discharge at that moment. Underwent surgery that confirmed the presence of endoanal pilonidal sinus. The sinus was opened and left to heal by secondary intention. The patient had good outcome with no signs of recurrence

Neoplasmas em suínos: 37 casos

Resumo: Neoplasmas em suínos são raros. Esse trabalho descreve os neoplasmas encontrados em suínos na rotina diagnóstica de um laboratório de patologia veterinária localizado na Região Central do Rio Grande do Sul. Durante um período de 49 anos, 2.266 casos de várias afecções em suínos foram encontrados, dos quais 37 (1,6%) eram neoplasmas. Em ordem decrescente de frequência, os seguintes neoplasmas foram encontrados: Linfoma (11/37), nefroblastoma (11/37), melanoma (8/37) e papiloma (2/37). Adicionalmente, um caso de cada um dos seguintes tumores foi observado: Adenoma hepatocelular, carcinoma hepatocelular, colangiocarcinoma, histiocitoma fibroso maligno e sarcoma granulocítico. O aspecto macroscópico e histológico desses tumores é descrito e a sua epidemiologia é comparada com os dados disponíveis na literatura para neoplasia suína