Giant Pleural Tumor And Severe Hypoglycemia: Doege-Potter Syndrome In A Previously Healthy Female.

AIntroduction: Doege-Potter's syndrome is a rare paraneoplastic syndrome, consisting in hypoglycemia and solitary fibrous tumor of the pleura. These tumors represent < 5% of all pleural tumours and can only be cured by surgery. In this article, we report a case of a patient presenting with severe hypoglycemia, as the only symptom, and a mass occupying the entire left hemithorax. Case presentation: A54 year old female with severe hypoglycemia, a chest radiography with almost total opacification of the left hemithorax and a computed tomography scan with a mass in the left hemithorax. Surgery was performed and a mass with 30cm × 18cm × 11cm weighing 3195g was resected. The postoperative course was uneventful with immediate resolution of the hypoglycemia. The immunohistochemistry diagnosis was solitary fibrous tumor of the pleura. Conclusions: Solitary fibrous tumor of the pleura are very rare. Less than 5% are associated with hypoglycemia, taking the form of Doege-Potter Syndrome. Radiation therapy and chemotherapy have shown low response rate and complete surgical resection is the only procedure that offers cure. This case reports describes a rare giant solitary fibrous tumor of the pleura with severe hypoglycemia, successfully treated by surgery. Long-term follow-up of the patient after the surgery is necessary for detection of any possible recurrence.

Metastatic Endocervical Adenocarcinoma in a Mature Cystic Teratoma: A Case of a Tumor-to-Tumor Metastasis.

Tumor-to-tumor metastasis is a rare phenomenon defined as a metastasis in a histologically distinct tumor. We report an unusual case of a 51-yr-old woman who presented with a cervical, bleeding lesion diagnosed as a poorly differentiated adenocarcinoma, HPV18+. Imaging studies revealed an unresectable cervical carcinoma with an associated left ovarian multicystic teratoma. A suspicious solid nodule within the teratoma was also reported. Bilateral salpingo-oophorectomy was performed before the cervical tumor was treated. Pathologic findings showed a multicystic tumor measuring 110×40×30 mm with an area of adenocarcinoma, morphologically similar to the cervical neoplasm. The immunoprofile obtained in the malignant ovarian component (p16+, carcinogenic embryonic antigen+, vimentin-, estrogen receptor-) was similar to the one in the cervix. Moreover, both lesions harbored HPV18. These findings confirmed the presence of a metastatic cervical adenocarcinoma in a mature cystic teratoma. In the differential diagnosis, both somatic malignant transformation of the mature cystic teratomas and the presence of a "collision tumor" were considered and are discussed in this case report.

[Video-assisted thoracic sympathectomy - the results from a center outpatient surgery program]. / Simpaticectomia torácica por vídeo-toracoscopia ­ experiência de um programa de cirurgia de ambulatório.

BACKGROUND: The outpatient surgery program from our department has started in 2014 to improve patient access to surgery and to reduce the surgical waitlist. Focused on the thoracic surgery, the most common intervention is the surgical treatment of primary hyperhidrosis by thoracic sympathectomy by video-assisted thoracoscopic surgery (VATS). It is performed according to the patient's symptoms, with section or application of surgical clips between R2-R5. MATERIALS AND METHODS: Retrospective study including all the patients submitted to thoracic sympathectomy by video- -assisted thoracoscopy surgery from our department's outpatient surgery program from January 2014 to January 2016. RESULTS: In our outpatient program we performed 198 thoracic sympathectomy by VATS. The mean age of the patients was 32,8 years old. 63,6% of the patients were females and 36.4% were males. From the 198 endoscopic thoracic sympathectomy performed, 181 (91,4%) were performed bilatellary with section between R3-R5, 12 (6,1%) were performed with the application of surgical clips in R2-R4 and 3 (1.5%) could not be performed due to the presence of pleuropulmonary adhesions. One of the patients was re-operated due to recurrent symptoms and another patients had surgery to remove the surgical clips (bilaterally in R2) due to exaggerated abdominal compensatory hyperhidrosis. Three patients had pneumothorax. CONCLUSION: The surgical treatment of primary hyperhidrosis was the most frequent procedure in our outpatient surgery program. The procedure without the use of a thoracic drainage allowed its inclusion in the outpatient surgery program. Excluding 3 patients, all the patients were discharged within 12 hours after the surgery. The good results and the reduction of the surgical waitlist encourage the cardiothoracic outpatient surgery program.

Introdução: O programa de cirurgia de ambulatório do Serviço de Cirurgia Cardiotorácica do HSM-CHLN iniciou-se em Janeiro de 2014, com o intuito de melhorar a acessibilidade dos pacientes e reduzir a lista de espera. Focada essencialmente na área da Cirurgia Torácica, a actividade de ambulatório assenta sobretudo no tratamento cirúrgico videoassistido (VATS) da hiperhidrose primária axilar e palmar. A correção da hiperhidrose axilar e palmar através da simpaticectomia torácica é realizada de acordo com os sintomas do doente, com laqueação uni ou bilateral ou aplicação de clips entre R2-R5. Neste artigo apresentamos a experiência do nosso serviço na realização de simpaticectomia torácica por VATS através do programa de Cirurgia de Ambulatório. Materiais e métodos: Estudo retrospectivo de análise de dados clínicos de doentes submetidos a simpaticectomia torácica por VATS através do programa de cirurgia de ambulatório entre Janeiro de 2014 e Janeiro de 2016. Resultados: Foram efectuadas 198 simpaticectomias torácicas por VATS no período descrito. Os pacientes tinham em média 32,8 anos, sendo 63.6% do sexo feminino e 36.4% do sexo masculino. Das 198 simpaticectomias torácicas por VATS realizadas, 181 (91,4%) foram bilaterais com laqueação ao nível de R3-R5, 12 (6,1%) foram realizadas com aplicação de clips em R2-R4, e em 3 doentes (1.5%) a cirurgia não pode ser realizadas pela presença de aderências pleuro-pulmonares. Um paciente foi submetido a novo procedimento por recorrência dos sintomas e outro paciente foi submetido a remoção dos clips aplicados bilateralmente em R2 por hiperhidrose abdominal compensatória acentuada. Três doentes desenvolveram pneumotórax. Conclusão: O tratamento cirúrgico da hiperhidrose palmar e axilar através da simpaticectomia bilateral constitui o procedimento mais frequente na cirurgia de ambulatório do Serviço de Cirurgia Cardiotorácica do Hospital de Santa Maria do Centro Hospitalar Lisboa Norte. A realização do procedimento sem colocação de drenagens torácicas permitiu realizá-lo no regime de ambulatório. Trata-se de um procedimento eficaz, com baixa taxa de recidiva de sinais e sintomas e com rápida recuperação. Com exceção de 3 doentes, todos tiveram alta nas primeiras 12h pós-operatório. Os bons resultados obtidos e a redução da lista de espera constituem um incentivo para a manutenção do programa de ambulatório da Cirurgia Cardiotorácica.

Incidental gossypiboma on contrast enema study.

This is a case report of a 50-year-old woman with HIV/HCV coinfection who was diagnosed with an HPV-related well-differentiated squamous cell carcinoma of the vulva. After undergoing modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy, the patient developed a rectovaginal fistula and a diverting colostomy was placed. During a postoperative contrast enema study, a curvilinear hyperdense stripe was noted, representing the radiodense marker thread of a retained surgical sponge. This case report highlights the importance of awareness of this retained surgical item and its associated possible complications, as well as the importance of imaging modalities for diagnosis.

Malignant peripheral nerve sheath tumor mimicking an adnexal mass: a radio-pathologic correlation.

We report the case of a pelvic malignant peripheral nerve sheath tumor mimicking an adnexal mass. A 59-year-old postmenopausal woman presented with a 3-month history of diffuse abdominal bloating and urinary frequency. Laboratory tests revealed an increased CA 125. Radiologic evaluation depicted a large, heterogeneous solid mass located right to the uterus, pushing it to the left. After a multidisciplinary board discussion, the diagnosis of a right adnexal lesion was assumed, and the patient was referred to surgery. The final diagnosis was only achieved after pathology examination, which prove to be a malignant peripheral nerve sheath tumor. This paper highlights some clinical, radiologic and pathological features of malignant peripheral nerve sheath tumors, a rare entity that should be considered as a differential in patients presenting with pelvic tumors of uncertain origin.

Beyond Apnea-Hypopnea Index: how clinical and comorbidity are important in obstructive sleep apnea.

INTRODUCTION: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comorbidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period. MATERIAL AND METHODS: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A-D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy. RESULTS: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6-15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO2 < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statistical differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D. CONCLUSIONS: The Baveno classification distributes patients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most symptomatic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision.

Lung cancer screening in clinical practice: identification of high-risk chronic obstructive pulmonary disease patients.

OBJECTIVE: The NELSON study demonstrated a positive association between computed tomography scanning and reduced mortality associated with lung cancer. The COPD-LUCSS-DLCO is a tool designed to improve screening selection criteria of lung cancer for chronic obstructive pulmonary disease patients. The aim of this study was to examine and compare the discriminating value of both scores in a community-based cohort of chronic obstructive pulmonary disease patients. METHODS: A retrospective study of chronic obstructive pulmonary disease patients followed in pulmonology consultation for a period of 10 years (2009-2019) was conducted. The NELSON criteria and COPD-LUCSS-DLCO score were calculated for each patient at the time of the study inclusion. The lung cancer incidence was calculated for each of the subgroups during the follow-up period. RESULTS: A total of 103 patients were included in the study (mean age 64.7±9.2 years, 88.3% male). Applying the COPD-LUCSS-DLCO score, high-risk patients have a 5.9-fold greater risk of developing lung cancer versus the low risk. In contrast, there was no significant association between NELSON selection criteria and lung cancer incidence. The area under the curve was 0.69 for COPD-LUCSS-DLCO and 0.59 for NELSON criteria. Comparing test results showed no differences. CONCLUSIONS: The use of the COPD-LUCSS-DLCO score in clinical practice can help to detect chronic obstructive pulmonary disease patients in greater risk of developing lung cancer with better performance than NELSON criteria. Therefore, models that include a risk biomarker strategy can improve selection criteria and consequently can enhance a better lung cancer prediction.

[Rupture of a bronchial artery aneurysm - a rare case of non-traumatic hemothorax]. / Rotura de aneurisma de artéria brônquica - um caso raro de hemotórax não traumático.

Bronchial circulation is a vascular territory rarely involved by pathology, with a few cases reported in the literature. The authors describe the clinical case of a bronchial artery aneurysm rupture, complicated by hemothorax, that required immediate surgery for effective control. The main features of the available knowledge about this rare entidy are analysed and discussed.

THORACIC SYMPATHECTOMY: SEDATION EXPERIENCE.

Introduction/Study Goals: Thoracic sympathectomy is considered to be the most effective treatment for hyperhidrosis, a procedure traditionally performed under general anesthesia. Nowadays it's a minimally invasive procedure, which makes it possible to perform under sedation with local anesthesia. The goal in this study was to assess the efficacy and safety of this anesthetic technique in video-assisted thoracic sympathectomy. MATERIAL AND METHODS: The study took place in Centro Hospitalar Universitário Lisboa Norte, between June 2017 and September 2019. The anesthetic technique consisted in a propofol infusion titrated to achieve a moderate to deep sedation, in addition to local anesthesia with lidocaine 2% and ropivacaine 0,75% on surgical incisions. All patients were assessed subsequently for pain and anesthetic or surgical complications, with a 30-day follow-up. RESULTS: From a final sample of 63 patients, most were female (70%), with age ranging between 15 and 57 years old. There were no intra-operative complications. On the immediate postoperative period there were only two cases of poorly controlled pain. CONCLUSION: Results showed efficiency and safety with sedation associated with local anaesthesia as an anaesthetic technique for video-assisted thoracic sympathectomy. This anaesthetic approach avoids possible complications associated with general anaesthesia and one lung ventilation, with good analgesic efficacy. However, there is still the need for a bigger sample to confirm the obtained results and to strengthen sedation as an anesthetic approach in thoracic sympathectomy.

A new wireless biosensor for intra-vaginal temperature monitoring.

Wireless Body Sensors for medical purposes offer valuable contributions to improve patients' healthcare, including diagnosis and/or therapeutics monitoring. Body temperature is a crucial parameter in healthcare diagnosis. In gynecology and obstetrics it is measured at the skin's surface, which is very influenced by the environment. This paper proposes a new intra-body sensor for long-term intra-vaginal temperature collection. The embedded IEEE 802.15.4 communication module allows the integration of this sensor in a Wireless Sensor Network (WSN) for remote data access and monitoring. We present the sensor architecture, the construction of the corresponding testbed, and its performance evaluation. This sensor may be used in different medical applications, including preterm labor prevention and fertility and ovulation period detection. The features of the constructed testbed were validated in laboratory tests verifying its accuracy and performance.

A Novel Intra-body Sensor for Vaginal Temperature Monitoring.

Over the years some medical studies have tried to better understand the internal behavior of human beings. Many researchers in this domain have been striving to find relationships between intra-vaginal temperature and certain female health conditions, such as ovulation and fertile period since woman's intra-vaginal temperature is one of the body parameters most preferred in such studies. However, due to lack of a appropriate technology, medical research devoted to studying correlations of such body parameters with certain womans' body phenomena could not obtain better results. This article presents the design and implementation of a novel intra-body sensor for acquisition and monitoring of intra-vaginal temperatures. This novel intra-body sensor provides data collection that is used for studying the relation between temperature variations and female health conditions, such as anticipation and monitoring of the ovulation period, detection of pregnancy contractions, preterm labor prevention, etc.. The motivation for this work focuses on the development of this new intra-body sensor that will represent a major step in medical technology. The novel sensor was tested and validated on hospitalized women as well as normal healthy women. Finally our medical team has attested to the accuracy, usability and performance of this novel intra-body sensor.

Lung cancer screening in clinical practice: identification of high-risk chronic obstructive pulmonary disease patients

SUMMARY OBJECTIVE: The NELSON study demonstrated a positive association between computed tomography scanning and reduced mortality associated with lung cancer. The COPD-LUCSS-DLCO is a tool designed to improve screening selection criteria of lung cancer for chronic obstructive pulmonary disease patients. The aim of this study was to examine and compare the discriminating value of both scores in a community-based cohort of chronic obstructive pulmonary disease patients. METHODS: A retrospective study of chronic obstructive pulmonary disease patients followed in pulmonology consultation for a period of 10 years (2009-2019) was conducted. The NELSON criteria and COPD-LUCSS-DLCO score were calculated for each patient at the time of the study inclusion. The lung cancer incidence was calculated for each of the subgroups during the follow-up period. RESULTS: A total of 103 patients were included in the study (mean age 64.7±9.2 years, 88.3% male). Applying the COPD-LUCSS-DLCO score, high-risk patients have a 5.9-fold greater risk of developing lung cancer versus the low risk. In contrast, there was no significant association between NELSON selection criteria and lung cancer incidence. The area under the curve was 0.69 for COPD-LUCSS-DLCO and 0.59 for NELSON criteria. Comparing test results showed no differences. CONCLUSIONS: The use of the COPD-LUCSS-DLCO score in clinical practice can help to detect chronic obstructive pulmonary disease patients in greater risk of developing lung cancer with better performance than NELSON criteria. Therefore, models that include a risk biomarker strategy can improve selection criteria and consequently can enhance a better lung cancer prediction.

New dual-stage pH control fed-batch cultivation strategy for the improvement of lipids and carotenoids production by the red yeast Rhodosporidium toruloides NCYC 921.

The optimal medium pH to produce biomass and fatty acids by the red yeast Rhodosporidium toruloides NCYC 921 is 4.0, and to produce carotenoids is 5.0. Based on this difference, a dual-stage pH control fed-batch cultivation strategy for the enhancement of lipids and carotenoids production by this yeast was studied. The results showed that when the yeast growth phase was conducted at pH 4.0, and the products accumulation phase was conducted at pH 5.0, biomass, total fatty acid and total carotenoid productivities were significantly improved comparing with the yeast fed batch cultivations carried out at fixed medium pH (4 or 5). Under dual-stage pH control conditions, the biomass, carotenoids and lipids productivities attained 2.35 g/Lh, 0.29 g/Lh and 0.40 g/Lh, respectively. It was also observed that the oxygen played a major role in the yeast carotenoid production.

Ação "Lazer Mais Saúde": experiências em promoção da atividade física nas Academias a Céu Aberto em Belo Horizonte, Minas Gerais, Brasil / "Lazer Mais Saúde" action: experiences in promoting physical activity at outdoor gyms in Belo Horizonte, Minas Gerais, Brazil

Este estudo objetivou desenvolver e apresentar o modelo lógico da ação Lazer Mais Saúde (LMS), associada à ação de instalação das Academias a Céu Aberto (ACA) em Belo Horizonte, Minas Gerais, Brasil. O modelo lógico foi baseado nas diretrizes do Center for Disease Control and Prevention. Foi realizado levantamento e análise de documentos e publicações oficiais produzidos entre 2009-2017. As primeiras ACA foram instaladas em 2010, totalizando 188 unidades em 2013 e 404 em 2017. O processo de instalação, manutenção, bem como, sensibilização e orientação de milhares de usuários das ACA foi conduzido. Em longo prazo, as ações vinculadas à ACA visam aumentar os níveis de atividade física de lazer na população-alvo e mitigar as desigualdades intra urbanas no acesso à atividade física. Este trabalho contribuiu para o registro sistemático das ações LMS e ACA em Belo Horizonte, Minas Gerais. O LMS foi aperfeiçoado continuamente, através de intervenções baseadas em evidências de gestão

This study aimed to develop the logical model of the "Lazer Mais Saúde" (LMS), related to outdoor gym implementation in Belo Horizonte, Minas Gerais, Brazil. The logical model was based on the Center for Disease Control and Prevention guidelines. A documental revision in official publications and reports produced between 2009 to 2017 was conducted. The outdoors gyms were installed in 2010, totaling 188 in 2013 and 404 in 2017. The installation, maintenance process, as well as raising awareness and guidance for thousands of users were accomplished. In the long term, outdoor gyms action aims to increase the levels of leisure-time physical activity to target groups and mitigate intra-urban inequalities in the access to physical activity facilities. This article contributed to the systematic register of LMS and outdoor gym actions in Belo Horizonte, Minas Gerais. The LMS has been continuously improved through the use of evidence-based management interventions

PT-symmetric quantum state discrimination.

The objective of this paper is to explain and elucidate the formalism of PT quantum mechanics by applying it to a well-known problem in conventional Hermitian quantum mechanics, namely the problem of state discrimination. Suppose that a system is known to be in one of two quantum states, |ψ(1)> or |ψ(2)>. If these states are not orthogonal, then the requirement of unitarity forbids the possibility of discriminating between these two states with one measurement; that is, determining with one measurement what state the system is in. In conventional quantum mechanics, there is a strategy in which successful state discrimination can be achieved with a single measurement but only with a success probability p that is less than unity. In this paper, the state-discrimination problem is examined in the context of PT quantum mechanics and the approach is based on the fact that a non-Hermitian PT-symmetric Hamiltonian determines the inner product that is appropriate for the Hilbert space of physical states. It is shown that it is always possible to choose this inner product so that the two states |ψ(1)> and |ψ(2)> are orthogonal. Using PT quantum mechanics, one cannot achieve a better state discrimination than in ordinary quantum mechanics, but one can instead perform a simulated quantum state discrimination, in which with a single measurement a perfect state discrimination is realized with probability p.