3 research outputs found
Myelolipoma of the posterior mediastinum in a patient with chronic dyserythropoietic anemia
Myelolipoma (ML) is an uncommon benign mesenchymal neoplasia composed of mature adipose and hematopoietic tissues of uncertain etiology. Less than 3% of MLs occur in the mediastinal topography. The main differential diagnosis involves extramedullary hematopoiesis; therefore, pathological evaluation is essential for the definitive diagnosis. The authors report the case of a 50-year-old man diagnosed with congenital dyserythropoiesis and secondary hemosiderosis, who presented a posterior mediastinal tumor. The tumor was resected. It was macroscopically characterized by mature fat tissue with fibrous areas and soft consistency, which was yellowish at the cut surface. Histology revealed a well-defined nodule composed of adipocytes and hematopoietic tissue represented by erythroid, granulocytic, and megakaryocytic series, which was consistent with the diagnosis of ML located in the posterior mediastinum. There was no recurrence of the lesion during the 3-year follow-up. The aim of this report is to show the diagnosis of an unusual mediastinal lesion in the context of a chronic hematologic diseas
Tratamento cirĂșrgico comparado ao tratamento clĂnico na miastenia gravis: revisĂŁo sistemĂĄtica e matanĂĄlise
Introduction: Myasthenia gravis is a disease that affects the neuromuscular junction and leads to weakness of the skeletal muscles. Current treatment is guided by the clinical and surgical conduction through the complete resection of the thymus. Objective: Compare, through a systematic review, the results of surgical and medical treatment of myasthenia gravis. Methods: A search was conducted in major databases to find randomized controlled trials that compared the two treatment modalities. As there are no studies that category, were selected studies with a lower level of evidence and that contained both interventions and at least 10 patients in each arm of the study. Statistical analysis was performed with StatsDirect version 3.0.121 software. Results: The search found 592 articles in Medline, 1925 articles in the Embase and 204 articles in the Lilacs. After exclusion of duplicate studies, 51 articles were fully analyzed and nine were selected for this review. The total number of patients was 3,211. The mortality in the surgical and medical groups were respectively 7 and 19%, with significant differences. The remission rate in both groups was 17% for the surgical group and 13% for clinical, without statistical significance. To improve the outcome, the surgical group had a rate of 23% and 29% of the clinical, also no statistical difference. Conclusion: Despite the low available evidence, thymectomy may be considered a therapeutic option in myasthenia gravis, with lower rates of mortality and rates of remission and control similar to clinical treatment Keywords: myasthenia gravis, thymectomy, clinical treatmentIntrodução: A miastenia gravis Ă© uma doença que afeta a junção neuromuscular e leva a fraqueza da musculatura esquelĂ©tica. O tratamento atual pode ser clĂnico ou cirĂșrgico atravĂ©s da ressecção completa do timo. Objetivo: Comparar, atravĂ©s de uma revisĂŁo sistemĂĄtica da literatura, os resultados do tratamento cirĂșrgico e clĂnico da miastenia gravis. MĂ©todos: Foi realizada uma busca nos principais bancos de dados a fim de encontrar ensaios clĂnicos randomizados que comparassem as duas modalidades terapĂȘuticas. Como nĂŁo existem estudos dessa categoria, foram selecionados aqueles com menor nĂvel de evidĂȘncia e que continham as duas intervençÔes, com pelo menos 10 pacientes em cada braço do estudo. A anĂĄlise estatĂstica foi feita com software StatsDirect, versĂŁo 3.0.121. Resultados: A busca encontrou 592 artigos na base Medline, 1925 artigos na base Embase e 204 artigos na base Lilacs. ApĂłs a exclusĂŁo dos estudos duplicados, 51 artigos foram analisados integralmente e nove foram selecionados para esta revisĂŁo. O nĂșmero total de pacientes avaliados foi de 3.211. A mortalidade nos grupos cirĂșrgico e clĂnico foram respectivamente de 7 e 19%, com diferença estatĂstica significante. A taxa de remissĂŁo nos grupos foi de 17% para o grupo cirĂșrgico e de 13% para o clĂnico, sem significĂąncia estatĂstica. Para o desfecho melhora, o grupo cirĂșrgico apresentou uma taxa de 23% e o clĂnico de 29%, tambĂ©m sem diferença estatĂstica. ConclusĂ”es: Apesar da baixa evidĂȘncia disponĂvel, a timectomia pode ser considerada uma opção terapĂȘutica na miastenia gravis, com menores Ăndices de mortalidade e taxas de remissĂŁo e controle semelhantes ao tratamento clĂnic