Angiostrongilíase abdominal: relato de dois casos com diferentes apresentações clínicas

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.A angiostrongilíase abdominal é doença esporádica decorrente da infecção pelo nematódeo Angiostrongylus costaricensis. Costuma manifestar-se como abdome agudo secundário a isquemia mesentérica, além de marcada eosinofilia. Pode também apresentar-se de forma insidiosa e transitória, exigindo alta suspeita clínica para o diagnóstico. A doença é confirmada pela identificação de elementos do A. costaricensis em peças cirúrgicas. O tratamento é apenas de suporte, devendo-se evitar o uso de anti-helmínticos pela possibilidade de migração errática do verme com piora do quadro. Aqui foram apresentados dois casos, ambos com acentuada eosinofilia e ELISA-IgG sérico positivo para A. costaricencis. O primeiro caso cursou com perfuração ileal e foi tratado cirurgicamente. O segundo caso apresentou nódulos hepáticos ao ultrassom e foi tratado sintomaticamente, evoluindo para lenta resolução. Estes dois casos exemplificam diferentes formas de apresentação clínica da doença, uma delas com envolvimento hepático

Reported mortality for colorectal cancer in Brazil in the first 16 years of the 21st century

Introduction: Colorectal cancer (CRC) is a malignant neoplasm with major impact on health today. There is, however, an efficient method for prevention and screening, which varies in different protocols according to each institution or country. Objective: To evaluate the mortality rate and the economic cost of CRC in Brazil during the first 16 years of the 21st century. Method: A retrospective, temporal aggregation study was conducted with an exploratory, documentary quantitative approach on CRC mortality from 2000 to 2016, based on the Mortality Information System database provided by the Brazilian Ministry of Health. Results: In the study period, 218,000 deaths due to CRC were recorded. The CRC mortality rate was 6.2 (95% confidence interval, 5.59-6.81) per 100,000 population, with no significant difference between men and women. Of the 17 age subgroups analyzed, eight had a significant increase from 2000 to 2016, including all subgroups aged over 50 years. Conclusion: There was an increase in mortality due to CRC in the study period. Keywords: Mortality; colorectal cancer; Brazi

Alterations in biomarkers of cardiovascular disease (CVD) in active acromegaly

Objectives: In acromegalic patients, cardiovascular and metabolic comorbidities contribute to enhance mortality. Available data on the lipoprotein profile of these patients are controversial. Our aim was to characterize the lipoprotein profile and emergent biomarkers of cardiovascular disease in active acromegalic patients in comparison with sex- and age-matched healthy controls. Patients: Eighteen patients with active acromegaly and 18 controls were studied. Measurements: Glucose levels, hormonal status, lipoprotein profile and C reactive protein (CRP) were evaluated by standardized methods. Cholesteryl ester transfer protein (CETP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) were measured by radiometric techniques, endothelin-1 and vascular cell adhesion molecule (VCAM)-1 by enzyme-linked immunosorbent assay, and leucocytes CD18, CD49d and CD54 by flow cytometry. Results: After adjusting for body mass index (BMI), acromegalic patients presented a more atherogenic lipoprotein profile, consisting of higher levels of triglycerides and apolipoprotein B and alterations in the ratios which estimate insulin resistance and atherogenic risk. CETP activity was significantly increased in acromegalic patients as compared to controls (168 ± 17 vs. 141 ± 30% per ml h, respectively; P < 0.05). Endothelin-1 levels evidenced an increase in the patients' group (0.9 ± 0.2 vs. 0.7 ± 0.2 ng/l, respectively; P < 0.01) and showed positive and significant correlations with GH, IGF-1 and IGFBP-3 (r = 0.45, 0.42 and 0.44, respectively; P < 0.01 for all of them; with BMI as a fixed variable). Lymphocytes from acromegalic patients showed increased CD49d content (282 ± 59 vs. 246 ± 48 arbitrary units, respectively; P < 0.05). Conclusions: Taken together, the alterations described seem to contribute to constituting a state of higher propensity for the development of atherosclerotic cardiovascular disease, which adds to the presence of specific cardiomyopathy.Fil: Boero, Laura Estela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Manavela, M.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Gomez Rosso, Leonardo Adrián. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Insua, C.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Berardi, V.. No especifíca;Fil: Fornari, M.C.. No especifíca;Fil: Brites, Fernando Daniel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Cisto Epidermóide de Baço em Paciente Previamente Hígido

Paciente feminina, 14 anos, previamente hígida, com queixa de dor lombar e em flanco esquerdo há seis meses. Apresentava também plenitude pós-prandial, de início concomitante aos outros sintomas. À palpação abdominal, percebia-se massa em hipocôndrio esquerdo e elevação do gradil costal do mesmo lado. A ultrassonografia evidenciou lesão esplênica bem delimitada, cística e unilocular. Hemograma, função hepática e renal estavam dentro da normalidade. A sorologia para hidatidose foi negativa. A tomografia contrastada revelou um processo expansivo hipodenso (Figura 1), medindo 16,3 X 12,5 cm, sugerindo cisto esplênico simples ou epidermóide. A paciente foi então submetida à esplenectomia videolaparoscópica (Figura 2), com aspiração do conteúdo do cisto e retirada da peça cirúrgica por uma incisão de Pfannenstiel. Não houve complicações pós-operatórias. O exame anatomopatológico mostrou baço de 415 g, exibindo cisto revestido por epitélio escamoso (cisto epidermóide)

Lupus Enteritis: A Case Report

Lupus enteritis is a rare presentation of systemic lupus erythematous, clinically manifested by abdominal pain, vomiting, and diarrhoea. Proper diagnosis and treatment are essential to avoid complications, including death. Here, the authors report a case of a 52-year-old White female who presented with abdominal pain and chronic diarrhoea, with diagnostic tests compatible with lupus enteritis. Such a condition is an uncommon manifestation of systemic lupus erythematosus, an autoimmune disease that affects young females, resulting from gastrointestinal involvement by small vessel vasculitis. Early detection and proper management of lupus enteritis are essential to improve long-term survival. The present case addresses the clinical characteristics of lupus enteritis, emphasising its pathophysiology, diagnosis, and treatment

Motilidade esofágica ineficaz (MEI) está associada com esofagite de refluxo (ER)?

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Variable morphologic expression of volcanic, tectonic, and hydrothermal processes at six hydrothermal vent fields in the Lau back-arc basin

Author Posting. © American Geophysical Union, 2008. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 9 (2008): Q07022, doi:10.1029/2008GC002047.Ultrahigh-resolution bathymetric maps (25 cm grid) are used to quantify the physical dimensions of and spatial relationships between tectonic, volcanic, and hydrothermal features at six hydrothermal vent fields in the Lau back-arc basin. Supplemented with near-bottom photos, and nested within regional DSL-120A side-scan sonar data, these maps provide insight into the nature of hydrothermal systems along the Eastern Lau Spreading Center (ELSC) and Valu Fa Ridge (VFR). Along-axis transitions evident in localized volcanic morphology and tectonic characteristics include a change from broad low-relief volcanic domes (hundreds of meters wide, <10 m tall) that are dominated by pillow and lobate lava morphologies and are cut by faults and fissures to higher aspect ratio volcanic domes (tens of meters wide, tens of meters tall) dominated by aa-type lava morphologies, with finger-like flows, and few tectonic structures. These along-axis differences in localized seafloor morphology suggest differences in hydrothermal circulation pathways within the shallow crust and correlate with regional transitions in a variety of ridge properties, including the large-scale morphology of the ridge axis (shallow axial valley to axial high), seafloor lava compositions, and seismic properties of the upper crust. Differences in morphologic characteristics of individual flows and lava types were also quantified, providing an important first step toward the remote characterization of complex terrains associated with hydrothermal vent fields.Support for field and laboratory studies was provided by the National Science Foundation under grant OCE02-41796 (M.K.T.). Additional support for data analysis and integration was provided by the National Science Foundation under grant OCE03-28117 (S.M.C.)

Overactive bladder-18 years - Part I

Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.Univ Fed Sao Paulo, EPM, Rua Dr Oscar Monteiro Barros 617-141, BR-05641010 Sao Paulo, SP, BrazilUniv Sao Paulo, Dept Urol, BR-05508 Sao Paulo, SP, BrazilFac Med ABC, Dept Urol, Sao Paulo, SP, BrazilUniv Los Andes, Dept Urol, Bogota, ColombiaEscuela Med, Dept Urol, Mexico City, DF, MexicoHosp Clin Jose San Martin, Catedra Urol, Buenos Aires, DF, ArgentinaMae de Deus Ctr Hosp, Dept Urol, Porto Alegre, RS, BrazilUniv Fed Ciencias Saude Porto Alegre, Porto Alegre, RS, BrazilAC Camargo Hosp, Dept Urol, Sao Paulo, BrazilHosp Clin Fuerza Area Chile, Santiago, ChileInst Mexicano Seguro Social, Mexico City, DF, MexicoHosp Souza Aguiar, Dept Urol, Rio De Janeiro, RJ, BrazilComplejo Med Policial Churruca Visca, Serv Urol, Buenos Aires, DF, ArgentinaCtr Policlin Valencia Vina, Valencia, VenezuelaHosp Pablo Tobon Uribe, Medellin, ColombiaClin Indisa, Serv Urol, Providencia, ChileCtr Reabilitacao & Readaptacao Dr Henriqe Santill, Goiania, Go, BrazilHosp Univ Caracas, Serv Urol, Caracas, VenezuelaUniv Fed Ceara, Div Urol, Fortaleza, Ceara, BrazilUniv Fed Sao Paulo, EPM, Rua Dr Oscar Monteiro Barros 617-141, BR-05641010 Sao Paulo, SP, BrazilWeb of Scienc

Overactive bladder-18 years - Part II

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.Univ Fed Sao Paulo, EPM, Sao Paulo, SP, BrazilUniv Sao Paulo, Dept Urol, BR-05508 Sao Paulo, SP, BrazilFac Med ABC, Dept Urol, Sao Paulo, SP, BrazilUniv Los Andes, Dept Urol, Bogota, ColombiaEscuela Med Mil, Dept Urol, Mexico City, DF, MexicoHosp Clin Jose San Martin, Catedra Urol, Buenos Aires, DF, ArgentinaMae de Deus Ctr Hosp, Dept Urol, Porto Alegre, RS, BrazilUniv Fed Ciencias Saude Porto Alegre, Porto Alegre, RS, BrazilAC Camargo Hosp, Dept Urol, Sao Paulo, SP, BrazilHosp Clinico Fuerza Area Chile, Santiago, ChileInst Mexicano Seguro Social, Mexico City, DF, MexicoHosp Souza Aguiar, Dept Urol, Rio De Janeiro, RJ, BrazilComplejo Med Policial Churruca Visca, Serv Urol, Buenos Aires, DF, ArgentinaCtr Policlin Valencia Vina, Valencia, VenezuelaHosp Pablo Tobon Uribe, Medellin, ColombiaClin Indisa, Serv Urol, Providencia, ChileCtr Reabilitacao & Readaptacao Dr Henriqe Santill, Goiania, Go, BrazilHosp Univ Caracas, Serv Urol, Caracas, VenezuelaUniv Fed Ceara, Div Urol, Fortaleza, Ceara, BrazilUniv Fed Sao Paulo, EPM, Sao Paulo, SP, BrazilWeb of Scienc

Síndrome de Caroli e carcinomatose peritoneal

Caroli’s syndrome is an uncommon disease, and it is characterized by the presenceof cystic dilation of the intrahepatic biliary tree, and of congenital fibrosis. It may act asa premalignant condition, and in some cases it may develop into cholangiocarcinoma.We report a case of Caroli’s syndrome that was diagnosed in a 37 year old male, andwich was diagnosed along with the development of peritoneal carcinomatosis ofunknown origin. The relevant literature is reviewed as well.A Síndrome de Caroli é uma entidade incomum caracterizada pela presença dedilatações císticas da árvore biliar intra-hepática e fibrose hepática congênita. Podecomportar-se como condição pré-maligna, evoluindo em alguns casos paracolangiocarcinoma. Relatamos um caso diagnosticado em paciente do sexo masculinode 37 anos de idade, complicado por carcinomatose peritoneal de sítio desconhecidoe revisamos a literatura