Rectal Metastases of Breast Carcinoma: A Case Report.

The scarcely reported hematogenous rectal metastases from breast cancer are rare and the diagnosis is challenging. They may be recognized before, concomitantly with, or after the diagnosis of the primary site of breast cancer. Invasive lobular cancer is the histological type more frequently described, and most of the affected patients have a late diagnosis. Tardive recognition is associated with poor outcomes, despite the management options. Endoscopic and imaging evaluations, mainly magnetic resonance studies, are useful, but the anatomopathological findings are mandatory to confirm the diagnostic hypothesis. We describe a middle-aged woman with advanced rectal metastases of unsuspected breast cancer found during the evaluation of manifestations due to intestinal implants. One must highlight long-term follow-up of breast cancers even if seeming in remission. The aim of this report is to enhance the suspicion index of primary health care workers.

Thoracic duct lymphangioma and chylous ascites in a 24-year-old female

Lymphangiomas are rare and correspond to 0.7% to 4.0% of mediastinal tumors, and isolated mediastinal location occurs in 1% of cases. They are benign tumors that originate from a congenital malformation of the lymphatic vessels and are diagnosed more frequently in children less than 2 years of age. Chylous ascites is a clinical manifestation of thoracic duct lymphangioma and is composed of lymph accumulation caused by dilation of this lymphatic channel. It appears milky in the peritoneal cavity, containing triglyceride levels higher than 200 mg/dl. We report the case of a young patient with chylous ascites and lymphangioma of the thoracic duct, who was conservatively treated with octreotide and a low-fat diet with medium-chain triglycerides.

Endemia do tabagismo no Brasil / Smoking endemic disease in Brazil

Comentários sobre o artigo de Rabahi e Alcântara, sob o título "Tendência temporal da endemia do tabagismo no Brasil", no qual os autores analisaram o papel desse grave problema de saúde pública na morbimortalidade por doenças respiratórias, cardiovasculares e neoplásicas. (AU)

Comments about the article by Rabahi and Alcântara, entitled "The temporal trend of the smoking endemic disease in Brazil", in which the authors analised the role of this severe problem of public health on the morbidity and mortality by respiratory, cardiovascular and neoplastic diseases. (AU)

Pneumonia in a patient with lung cancer / Pneumonia em paciente com câncer pulmonar

The aim of the present report is to alert health care workers about a 64­year­old patient diagnosed with adenocarcinoma in the right lung treated with pemetrexed disodium, cisplatin and dexamethasone. He evolved with prolonged neutropenia, symptoms of lower airways infection, and recent pulmonary infiltrate in the radiographic image. The cultures for bacteria and mycobacteria in the blood and sputum were negative. Because of the lack of response to treatment with broad spectrum antibiotics and maintenance of neutropenia, a transbronchial biopsy was performed, which demonstrated infection by Aspergillus fumigatus. The patient was treated.

O objetivo do presente relato é alertar os profissionais de saúde sobre o caso de um paciente de 64 anos de idade com diagnóstico de adenocarcinoma no pulmão direito tratado com pemetrexede dissódico, cisplatina e dexametasona. Ele evoluiu com neutropenia prolongada, sintomas de infecção de vias aéreas inferiores e infiltrado pulmonar recente na imagem radiográfica. As culturas para bactérias e micobactérias no sangue e escarro foram negativas. Por falha na resposta ao tratamento com antibióticos de largo espectro e manutenção da neutropenia, foi realizada biópsia transbrônquica que demonstrou infecção por Aspergillus fumigatus e o paciente foi tratado.

Caput Medusae due to portal hypertension in schistosomiasis mansoni / Cabeza de Medusa debida a la hipertensión portal en esquistosomiasis mansoni

A 62-year-old Brazilian man who lived in endemic areas of tropical diseases had an episode of hematemesis associated with portal hypertension. He used to swim in natural ponds during childhood and developed the hepatosplenic form of schistossomiasis with moderate ascites, in addition to the characteristic features of abdominal Caput Medusae. The aim of the report is highlight the role of chronic liver disease and schistossomiasis

Un hombre natural de Brasil de 62 años de edad que vivía en zonas endémicas de enfermedades tropicales presentó un episodio de hematemesis asociada con hipertensión portal. Frecuentemente se bañaba en los estanques naturales durante la infancia y desarrolló la forma hepatosplénica de la esquistosomiasis con ascitis moderada, además de los rasgos abdominales característicos de la Cabeza de Medusa. El objetivo del informe es poner de relieve el papel de la enfermedad hepática crónica y de la esquistosomiasis

Parotid Cystic Lesion in Amelanotic Malignant Melanoma.

A 60-year Brazilian woman, presented with an enlarged lymph node in the neck for one year, and a superficial nonulcerated lesion was observed in the scalp. Fine needle aspiration and biopsy of the lymph node revealed amelanocytic metastasis, and immunohistochemistry study showed Melan-A/ Mart-1 antigen (clone A103 and S-100 protein). The entire suspected area of the scalp was further resected and an amelanotic melanoma without angiolymphatic invasion was diagnosed. Ultrasonography and PET-computed tomography showed hypermetabolic cystic area in the right parotid. Furthermore, aspiration biopsy and surgical samples from parotid cyst confirmed the malignant amelanotic melanoma. Cystic metastases are scarcely reported in parotid gland, and can pose diagnostic challenges.

Achados Ecocardiográficos em Pacientes com Hiperparatireoidismo Secundário / Echocardiographic Findings in Patients with Secondary Hyperparathyreoidism

Doenças cardiovasculares são frequentes no curso da insuficiência renal crônica, constituem importante causa de óbito, e causam 1/3 das hospitalizações de doentes dialíticos. Hiperparatireoidismo secundárioé o distúrbio metabólico mais comum na insuficiência renal, cuja fisiopatologia envolve alterações no equilíbriodo cálcio, fósforo, calcitriol e paratormônio. Objetivo: Avaliar a prevalência de alterações ecocardiográficas em pacientes renais crônicos com hiperparatireoidismo secundário, de acordo com níveis plasmáticos de paratormônio.Métodos: Estudo retrospectivo, realizado com base em dados registrados em prontuários entre 2005 e 2007,incluindo 52 indivíduos de ambos os sexos, com doença renal crônica em programa regular de diálise, estratificados com base nos níveis plasmáticos de paratormônio em três grupos: Grupo I ≤ 299pg/mL (n=10); Grupo II entre 300-499 pg/mL (n=21); e Grupo III ≥500 pg/mL (n=21). Foram avaliados os seguintes parâmetros ecocardiográficos: diâmetros da raiz da aorta, do átrio esquerdo e dos ventrículos; espessuras do septo e da parede posterior; fração de ejeção; e volumes diastólico e sistólico finais.Resultados: A análise comparativa dos achados ecocardiográficos nos três grupos revelou que a única variávelque apresentou significância estatística (p 0,009) foi a espessura diastólica da parede posterior. Conclusão: Doentes renais crônicos com hiperparatireoidismo secundário podem apresentar alteraçõesecocardiográficas, algumas das quais apresentam correlação com níveis circulantes de paratormônio....

Background: Cardiovascular diseases are frequent in the course of chronic kidney disease, are an important cause of death, and cause 1/3 of hospitalizations of patients on dialysis. Secondary hyperparathyroidism is the most common metabolic disorder in kidney failure. Its pathophysiology involves changes in the balance of calcium, phosphorus, calcitriol and parathyroid hormone. Objective: To assess the prevalence of echocardiographic abnormalities in chronic kidney disease patients with secondaryhyperparathyroidism, according to plasma levels of parathyroid hormone.Methods: Retrospective study conducted based on data recorded in medical records between 2005 and 2007, including 52 individuals of both sexes with chronic kidney disease on a regular dialysis program, stratified based on plasma levels of parathyroid hormoneinto three groups: Group I ≤ 299pg/mL (n=10); Group II between 300-499 pg/mL (n=21); and Group III ≥500 pg/mL (n=21).We evaluated the following echocardiographic parameters: aortic root diameter, left atrial and ventricular diameter; septal and posteriorwall thickness; ejection fraction; and end diastolic and systolic volumes. Results: The comparative analysis of the echocardiographic findings in the three groups revealed that the only variable presenting statistical significance (p 0.009) was diastolic posterior wall thickness. Conclusion: Patients with chronic kidney disease with secondary hyperparathyroidism may present echocardiographic changes, some of which correlate with circulating levels of parathyroid hormone...