RESUMO
BACKGROUND: Verrucous carcinoma of the esophagus is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult because even repeated biopsies are often without tumor evidence. We present a patient with verrucous carcinoma of the esophagus and a literature review. CASE REPORT: A 64-year-old patient with dysphagia and sore throat received esophagogastroduodenoscopy illustrating segmental circumferential verrucous inflammation and Candida esophagitis in the middle part of the esophagus. Repeated mucosal biopsies revealed reactive hyperkeratosis of the squamous epithelium with minimal atypia but without ulcera, eosinophilic esophagitis, or suspicion of cancer. Mucosal infection with adenovirus, herpes simplex virus 1, human papilloma virus types, and cytomegaly virus was ruled out. Veruccous carcinoma was detected finally by endoscopic mucosal resection. The patient was successfully treated by esophageal resection. Tumor stage was G1, pT1b, pN0, L0, V0, Pn0, R0. CONCLUSION: The results suggest that macroscopic suspicion of verrucous esophageal carcinoma should lead to resections of larger tissue specimens by EMR to confirm the diagnosis.
Assuntos
Carcinoma Verrucoso/patologia , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/patologia , Faringite/etiologia , Biópsia , Carcinoma Verrucoso/cirurgia , Ressecção Endoscópica de Mucosa , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We report a case of torsade de pointes secondary to acute QT interval prolongation in a patient with poorly controlled diabetes mellitus towards the end of a laparoscopic nephrectomy under sevoflurane anaesthesia. The patient was successfully resuscitated and made a complete recovery. Our case suggests that acute QT interval prolongation should be considered in any patient with poor glycaemic control during prolonged procedures.
Assuntos
Anestésicos Inalatórios/farmacologia , Diabetes Mellitus Tipo 2/complicações , Síndrome do QT Longo/etiologia , Éteres Metílicos/farmacologia , Torsades de Pointes/etiologia , Doença Aguda , Idoso , Eletrocardiografia , Feminino , Humanos , SevofluranoRESUMO
Of 686 hemophiliacs who are being treated at our institution, 402 (59%) are HIV-sero-positive. One hundred seventy-eight heterosexual partners of HIV-infected hemophiliacs have been serologically examined; 19 (11%) are HIV-positive. So far none of the seropositive partners suffers from ARC or AIDS. The rate of heterosexual transmission of HIV is statistically significantly correlated with the CD4+ count of the HIV-infected index patient. No such correlation was found with the index patient's clinical stage or the isolation of HIV from the index patient's blood. Of 39 seronegative female partners who were investigated clinically and immunologically, 17 showed pathologically increased numbers of CD8+ counts. In one case, HIV was transmitted from a female patient with von Willebrand's disease to her husband. As compared to other groups at risk for AIDS, the rate of heterosexual HIV transmission is comparatively low in hemophiliacs. The exact reason for this difference is not yet known. The relevance of the immunopathological findings in seronegative sexual partners of hemophiliacs also remains to be determined.
Assuntos
Infecções por HIV/transmissão , Hemofilia A/complicações , Comportamento Sexual , Adulto , Linfócitos T CD4-Positivos , Feminino , Infecções por HIV/etiologia , Soropositividade para HIV , Hemofilia A/imunologia , Humanos , Masculino , Linfócitos T Reguladores , Doenças de von Willebrand/complicaçõesRESUMO
A linfoistiocitose hematogocítica (LH) constitui uma síndrome clínico-patológica associada à febre pancitopenia severa, disfunçäo hepática e distúrbio da coagulaçäo, com hematofagocitose no nível da medula óssea e órgäos linfóides. Ocorre em pacientes imunossuprimidos, sendo induzida por infecçöes bacterianas, viróticas, fúngicas e parasitárias, bem como neoplasias, especialmente os linfomas de células T. Este trabalho relata o primeiro caso do nosso conhecimento de LH em transplante renal no Brasil, discutindo-se a etiologia, fisiopatogenia, manifestaçoös clínicas e tratamento da doença.
Assuntos
Humanos , Feminino , Adulto , Transplante de Rim , Histiocitose de Células não Langerhans/virologia , Histiocitose de Células não Langerhans/patologiaRESUMO
Os autores relatam um caso de síndrome da imunodeficiência adquirida em paciente heterossexual, politransfundido, que manifestou a doença dois meses após ter sido submetido a retransplante renal com rim de cadáver, evoluindo para óbito após seis meses. Apresentou durante a evoluçäo da doença infecçäo pulmonar grave por citomegalovírus e digestiva por Candida albicans, porém a causa da morte foi hemorragia digestiva alta. Discutem a incidência, via de transmissäo e profilaxia da doença em pacientes submetidos a transplante renal