ABSTRACT
POEMS syndrome is a rare paraneoplastic condition associated with polyneuropathy, organomegaly, monoclonal gammopathy, endocrine and skin changes. We report a case of a man with Castleman disease and monoclonal gammopathy, with a history of chronic diarrhoea and asthenia. Gastrointestinal involvement in POEMS syndrome is not frequently referred to in the literature and its physiopathology is not fully understood. Diagnostic criteria were met during hospitalization but considering the patient's overall health condition, therapeutic options were limited. Current treatment for POEMS syndrome depends on the management of the underlying plasma cell disorder. This report outlines the importance of a thorough review of systems and a physical examination to allow an attempted diagnosis and appropriate treatment. LEARNING POINTS: POEMS syndrome should be suspected in the presence of peripheral polyneuropathy associated with monoclonal gammopathy; diagnostic workup is challenging and delay in treatment is very common.Gastrointestinal involvement is not frequent and initial presentation with chronic diarrhoea is unusual and rarely mentioned in the literature.There is no consensus on the therapeutic approach, which can include autologous transplantation and chemotherapy. Frequently, these patients present fatigue, weight loss and sarcopenia with reduction of performance status, limiting subsequent therapeutic options.
ABSTRACT
A 70-year-old woman presented to the emergency department with symptoms of a lower respiratory infection. A chest x-ray showed enlargement of the mediastinal space. The patient was admitted with a respiratory tract infection and started on antibiotic treatment. A computed tomography (CT) scan of the thorax revealed a large diaphragmatic hernia with stomach, large intestine and caudal pancreas lodged in the thoracic cavity. After the antibiotic treatment, the patient became asymptomatic and surgery repair was declined. Morgagni hernia is an uncommon type of congenital diaphragmatic hernia, which may be asymptomatic until late in life or may be present acutely with life threatening conditions. LEARNING POINTS: Morgagni hernia is the most rare form of congenital hernia, representing 2 to 3% of all cases.Chronic respiratory symptoms or gastrointestinal disturbances can be the only manifestation.Most asymptomatic cases in adults are found after doing chest x-ray for unrelated problems.
ABSTRACT
Yellow Nail Syndrome (YNS) is a rare, and probably misdiagnosed, condition. It must be considered in middle-aged patients with unexplained chronic respiratory manifestations, lymphedema and nail abnormalities. We present two cases of undiagnosed YNS until the current admissions, despite several years of investigation. The authors wish to draw attention to this syndrome, of which diagnosis is clinical and of exclusion. LEARNING POINTS: Yellow nail syndrome is characterized by abnormal nails, lymphedema and respiratory manifestation.Diagnosis is clinical and should raise the suspicion of underlying medical conditions. The treatment is symptomatic.
ABSTRACT
É apresentado um caso de prenhez ectópica abdominal gemelar de 32 semanas. Pöe-se em evidência a raridade da patologia associada à gemelidade, havendo ainda a singularidade da constataçäo de extensa soluçäo de continuidade no fundo uterino implicando na realizaçäo de histerectomia subtotal. Há citaçäo de até três fetos tubários. A prenhez combinada raríssima já foi tese de pós-graduaçäo em Obstetrícia
Subject(s)
Pregnancy , Adult , Humans , Female , Pregnancy, Abdominal , Pregnancy, MultipleABSTRACT
Desde sempre, o feto em apresentaçäo pélvica motiva controvérsias. Exige do tirocínio do tocólogo, vez que de sua vivência dependerá a assistência ao parto. De Lee escreveu: "Deixem-me ver um Obstetra atender ao parto pélvico e eu lhes direi de sua qualidade." Entre as apresentaçöes anômalas, é a mais freqüente: 3 a 4%, no dizer de Morgan. Em sua etiologia figuram causas maternas (multiparidade, malformaçöes uterinas, tumoraçöes prévias e vícios de bacia), fetais (prematuridade, gemelidade, hidrocefalia) e vinculadas aos anexos: polidrâmnio, placentaçäo baixa, circulares do cordäo. Camano cita 43% de casos de trissomia, 18 a 40% na síndrome fetal do alcoolismo materno. Neme apurou 20,6% de apresentaçöes pélvicas em 34 casos de conceptos com síndrome de Down. A parturiçäo per vaginam é desejável, mas à medida que se exteriorizam os segmentos fetais, cresce a dificuldade e surge o óbice da cabeça derradeira; sua libertaçäo, consoante o procedimento de Bracht, oferece os melhores resultados. Rezende mostra-se favorável ao parto cesáreo na prematuridade, por amenizar os tocotraumatismos. Em 1984, na 33ª Enfermaria, houve 22 cesarianas em primíparas e quatro partos dirigidos; dois natimortos. O parto transpélvico deve ser ensinado, malgrado o aprendizado difícil das diferentes manobras. Muitas pacientes säo internadas em pleno trabalho de parto e sua assistência demanda desteridade. Os trabalhos da Escola de Nancy sobre o parto pélvico mostram que o feto assim apresentado pode palmilhar o canal pelvigenital sem manuseio do Obstetra, e vantajosamente
Subject(s)
Pregnancy , Humans , Female , Labor Presentation , ParturitionABSTRACT
Estudaram-se as 15 gemeligestas, num total de 1.552 partos havidos na 33ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro (Serviço do Professor Jorge de Rezende). A parturiçäo teve como via preferencial o canal pelvegenital num percentual de 53,3% e 46,7% para o parto cesáreo
Subject(s)
Pregnancy , Humans , Female , Labor, Obstetric , Pregnancy, Multiple , Brazil , RiskABSTRACT
No trabalho ora apresentado os AA constataram que a via abdominal predominou na conduta adotada na M.C.D. no ano de 1982. Houve 16 casos em apreço num total de 4.958 partos, sem que se registrasse nenhum êxito letal no que se refere às parturientes, e a mortalidade perinatal foi assaz inferior à assinalada em compêndios e trabalhos publicados
