ABSTRACT
A case report of a HIV seropositive 8-year-old child with vulvar and anal border neoplasia, both grade 3, and the adopted therapeutic management are presented. The mother reported the history of a progressively growing verrucous lesion in the vulva since the age of three and a half years. On physical examination a pigmented and elevated lesion was observed in the whole vulvar region extending to the anal region and intergluteal sulcus. After biopsies and anatomic pathological examination, antiretroviral therapy, adequate for age, and topical application of podophyllotoxin associated with Thuya officinalis extract was started. Three months afterwards vaporization and CO2 laser excision were performed in five sequential sessions, thereafter associated with topical imiquimod application. After the first two sessions of laser therapy early relapses occurred. After four weeks of imiquimod use, already a significant improvement of the lesions was observed, making the following laser therapy sessions easier. We conclude that antiretroviral therapy associated with podophyllotoxin and Thuya was not effective regarding regression of the lesions. Laser therapy alone led to early relapses. The local use of imiquimod associated with laser was effective in decreasing and controling the lesions.
Subject(s)
Anus Neoplasms/therapy , Carcinoma/therapy , HIV Infections/diagnosis , HIV Infections/drug therapy , Vulvar Neoplasms/therapy , Administration, Topical , Aminoquinolines/administration & dosage , Anti-HIV Agents/therapeutic use , Anus Neoplasms/pathology , Carcinoma/pathology , Child , Combined Modality Therapy , Female , Follow-Up Studies , HIV Infections/immunology , HIV Seropositivity , Humans , Imiquimod , Immunocompromised Host , Low-Level Light Therapy/methods , Papillomavirus Infections/pathology , Papillomavirus Infections/therapy , Risk Assessment , Treatment Outcome , Vulvar Neoplasms/pathologyABSTRACT
Cystic duct duplication with a single gallbladder is one of the most uncommon abnormalities of the biliary tract, with fewer than 15 instances published. The authors describe a 49-year-old patient undergoing a laparoscopic cholecystectomy in whom a second cystic duct was found, initially misdiagnosed as the biliary tract. The cholecystectomy was performed successfully with the aid of intraoperative cholangiography. It is the first time a duplicated cystic duct has been treated successfully using a laparoscopic approach.
Subject(s)
Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Cystic Duct/abnormalities , Female , Humans , Middle AgedABSTRACT
Os autores fazem uma revisao de colangites agudas comparando os resultados dos tratamentos cirurgicos com os obtidos em esfinctomia endoscopicas