Traumatic pseudoaneurysm in brachial artery after removal of a subdermal contraceptive implant.

The frequency of invasive therapeutic procedures has increased as medicine evolves, and the number of complications related to them has increased as a consequence. Subdermal contraceptive implants (SCI) offer benefits for female contraception, but implant and removal are associated with a complication rate of around 3%. In this article, we report and discuss a case of traumatic brachial artery pseudoaneurysm after an attempt to remove an SCI, complicated by compression of the median nerve.

Pseudoaneurisma traumático em artéria braquial após retirada de implante contraceptivo subdérmico / Traumatic pseudoaneurysm in brachial artery after removal of a subdermal contraceptive implant

Resumo Os procedimentos terapêuticos invasivos têm aumentado frequentemente com a evolução da medicina, consequentemente aumentando o número de complicações decorrentes deles. O dispositivo contraceptivo subdérmico (DCS) tem um benefício para a contracepção feminina, mas o implante e a retirada apresentam uma taxa de complicações em torno de 3%. Neste artigo, relatamos e discutimos um caso de pseudoaneurisma traumático da artéria braquial após tentativa de retirada do implante, complicada com a compressão do nervo mediano.

Abstract The frequency of invasive therapeutic procedures has increased as medicine evolves, and the number of complications related to them has increased as a consequence. Subdermal contraceptive implants (SCI) offer benefits for female contraception, but implant and removal are associated with a complication rate of around 3%. In this article, we report and discuss a case of traumatic brachial artery pseudoaneurysm after an attempt to remove an SCI, complicated by compression of the median nerve.

Silent ureteral stones: impact on kidney function--can treatment of silent ureteral stones preserve kidney function?

OBJECTIVE: To report our experience with silent ureteral stones and expose their true influence on renal function. METHODS: We analyzed 506 patients who had undergone ureterolithotripsy from January 2005 to May 2010. Silent ureteral stones were calculi found in the absence of any specific or subjective ureteral stone-related symptoms. Of the 506 patients, 27 (5.3%) met these criteria (global cohort). All patients were assessed postoperatively with dimercaptosuccinic acid scintigraphy (DMSA). A difference in relative kidney function of >10% was considered abnormal. Pre- and postoperative comparative DMSA analyses were electively obtained for 9 patients (kidney function cohort). A t test was used to assess the numeric variables, and the chi-square test or Fisher's exact test was used for categorical variables. Two-tailed P<.05 was considered statistically significant. RESULTS: Stones were diagnosed by radiologic abdominal evaluation for nonurologic diseases in 40% and after previous nephrolithiasis treatment in 33%. The primary therapy was ureterolithotripsy in 88%. The mean follow-up time was 23 months. The overall ureteral stone-free rate after 1 and 2 procedures was 96% and 100%, respectively. In the global cohort, the mean pre- and postoperative serum creatinine levels were similar (P=.39), and the mean postoperative function on DMSA was 31%. In the kidney function cohort, no difference was found between the pre- and postoperative DMSA findings (22%±12.1% vs 20%±11.8%; P=.83) and serum creatinine (0.8±0.13 mg/dL vs 1.0±0.21 mg/dL; P=.45). CONCLUSION: Silent ureteral stones are associated with decreased kidney function present at the diagnosis. Hydronephrosis tends to diminish after stone removal, and kidney function remains unaltered.

Lipomatose cervical benigna: doença de Madelung / Benign cervical lipomatosis: Madelung's disease

A doença de Madelung é caracterizada por deposição múltipla e simétrica de gordura, acometendo preferencialmente a extremidade superior do corpo, com tendência à recidiva após o tratamento. Difere de outras lipomatoses pela ausência de cápsula envolvendo a lesão. O gênero masculino é o mais acometido. A etiologia parece estar relacionada a uma disfunção mitocondrial ocasionando uma lipólise deficiente. Etilismo está associado à maioria dos casos. A única abordagem terapêutica é o tratamento cirúrgico com remoção das lesões. Apresentamos o caso de um paciente do gênero masculino, etilista, submetido à cirurgia para tratamento da DM.

The Madelung's Disease is characterized by multiple and symmetric fat tissue deposition, affecting the upper body extremity, and with tendency to recurrence after the treatment. There is no capsule involving the lesions, which differs from other lipomatosis. Men are more affected. The etiology seems to be related to the mitochondrial dysfunction resulting in deficient lipolisis. Alcoholism is associated in most cases. The only possible therapeutic approach is surgery with resection of the lesions. We report the case of a man with chronic alcohol use history, submitted to surgery for treatment of the disease.

Histiocitoma fibroso maligno de região cervical / Malignant fibrous histiocytoma of cervical region

Os sarcomas de partes moles (SPM) correspondem a apenas 1% dos tumores malignos. O mais freqüente é o histiocitoma fibroso maligno (HFM), caracterizado por invasão e disseminação metastática precoce. Nosso objetivo é descrever um caso de HFM submetido à cirurgia e radioterapia adjuvante. Paciente do gênero masculino, 49 anos, apresentava massa cervical. A análise histológica evidenciou HFM. Foi submetido à exérese cirúrgica da lesão e radioterapia adjuvante. O HFM é um tumor raro que deve fazer parte do diagnóstico diferencial das lesões cervicais primárias. A cirurgia é o tratamento de escolha associado à radioterapia pós-operatória.

Soft tissue sarcomas (STS) accounts for only 1% of malignancies. Malignant fibrous histiocytoma (MFH) is the most frequent, being characterized by invasion and early metastatic dissemination. The aim is to report a MFH case submitted to surgery and postoperative radiotherapy. A 49-year-old man presented neck mass. The histological analysis showed MFH. The patient underwent surgical resection and adjuvant radiation therapy. MFH is a rare tumor that should be part of primary neck lesions differential diagnosis. Surgery is the main treatment associated to radiotherapy.

Aspectos clínicos e histopatológicos de tumores de palato mole / Clinical and histopathological aspects of soft palate tumors

Introdução: Os tumores do palato mole podem ser classificados de acordo com seu comportamento em benignos e malignos. Os tumores benignos mais freqüentes são os papilomas, os tumores mistos (adenoma pleomórfico) e os schwannomas. Entre os tumores malignos, 95% são carcinomas espinocelulares e os outros 5% agrupam os tumores de glândulas salivares menores, linfomas, melanomas e outras entidades raras. Objetivo: O objetivo deste trabalho foi avaliar a ocorrência de tumores malignos e benignos de palato mole, bem como os tipos de tumores mais freqüentes em cada um destes dois grupos e relacioná-los com a faixa etária, sexo e aspecto macroscópico das lesões. Método: Foi realizada uma análise retrospectiva entre os anos de 1995 e 2005 dos pacientes atendidos no ambulatório de Cirurgia de Cabeça e Pescoço da Instituição. Resultados: Dos 43 pacientes, 10 apresentaram tumores malignos (23%) e 33 pacientes tumores benignos (77%). Dentre todos os tipos de tumores, 26 eram papilomas (60,5%); 9 eram carcinomas espinocelulares (21%); 4 eram hemangiomas (9,3%); 2 eram adenomas pleomórficos (4,6%); 1 era adenocarcinoma (2,3%) e 1 era lipoma (2,3%). Conclusão: Observou-se um predomínio de neoplasias de origem epitelial, tanto nos tumores benignos quanto nos malignos, o que é devido à maior proporção de tecido epitelial em relação aos demais no palato mole.

Introduction: The tumors of the soft palate can be classified according to its benign and malignant behavior. The most frequent benign tumors are the papillomas; the mixed tumors (pleomorphic adenoma) and the schwanomas. Among malignant tumors, 95% are squamous cell carcinoma and the 5% left are represented by minor salivary glands tumors, lymphomas, melanomas and other rare entities. Objective: The objective of this work was to evaluate the frequency of benign and malignant tumors of the soft palate, as well the most frequent kinds of tumors in each group and to relate them with age, gender and macroscopic aspect. Method: A retrospective analysis included the patients seen at the Head and Neck Surgery clinic of the Institution. Results: From the 43 patients, 10 of them presented malignant tumors (23%) and 33 presented benign tumors (77%). Among all of the tumors, 26 were papillomas (60.5%); 9 were squamous cell carcinomas (21%); 4 were hemangiomas (9.3%); 2 were pleomorphic adenomas (4.6%); 1 was adenocarcinoma (2.3%) and 1 was lipoma (2.3%). Conclusion: It was noticed that epithelial tumors are the most frequent in both malignant and benign groups, what is related to the predominant epithelial tissue in soft palate.

Laparaoscopic anti-reflux platy: experience of the University of Sao Paulo / Plastia antirreflujo laparoscópica: experiencia de la universidad de Sao Paulo

Objectives: Vesico-ureteric reflux (VUR) is a common cause of urinary tract infections in children, being less commonly diagnosed in adults. Several anti-reflux plasties have been used successfully for the treatment of such condition, such as Politano-Leadbetter, Cohen and Gregoir-Lich techniques, the latter being our preferred approach in open procedures. Here we describe our experience with laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) in children and adults. Methods: The LGLP was used for the treatment of VUR in 15 patients (7 adults and 8 children). Four adults and 5 children had bilateral disease and both sides were treated at the same procedure. Data was collected prospectively and we analysed age at treatment, laterality, degree of VUR, previous anti-reflux procedures, operative time, number of detrusor stitches used in each side, intra-operative and post-operative complications, success rate and follow-up. Results: A total of 23 ureteral units were treated. VUR was graded as I in one unit, II in 4 units, III in 10 units, IV in 7 units and 1 unit was not classified, as it was diagnosed by radioisotopic cystography. Two children had failed previous endoscopic procedures. There were no open conversions. Two muccosal perforations occurred during the procedure and were successfully treated laparoscopically. Nineteen out of 21 ureteral units (90%) presented no VUR at the cystographic control, and no bladder dysfunction was identified on follow-up. Conclusions: The LGLP is a feasible, minimally invasive alternative for VUR that reproduces the open procedure. It has an excelent success rate and is not associated to bladder disfunction, even in bilateral procedures (AU)

Objetivo: El reflujo vesicoureteral (RVU) es una causa común de infecciones del tracto urinario en niños, siendo diagnosticado con menos frecuencia en adultos. Se han utilizado varias técnicas antirreflujo para el tratamiento de dicha condición, como las técnicas de Politano-Leadbetter, Cohen y Gregoir-Lich, siendo ésta última nuestro abordaje preferido en cirugía abierta. Describimos nuestra experiencia con la plastia antirreflujo laparoscópica de Gregoir-Lich en niños y adultos. Métodos: La plastia de Gregoir-Lich laparoscópica fue utilizada en el tratamiento del RVU en 15 pacientes (7 adultos y 8 niños). Cuatro adultos y cinco niños respectivamente tenían reflujo bilateral, tratándose ambos lados en el mismo acto quirúrgico. Los datos fueron recogidos prospectivamente y se analizó edad en el momento el tratamiento, lado, grado de RVU, operaciones antirreflujo previas, tiempo operatorio, número de puntos del detrusor utilizados en cada lado, complicaciones intra y postoperatorias, tasa de éxitos y seguimiento. Resultados: Se trataron un total de 23 unidades ureterales. El RVU fue grado I en 1 uréter, II en 4, III en 10 y IV en 7, en un uréter no se asignó grado porque se diagnosticó mediante cistografía radioisotópica. Dos niños habían tenido operaciones endoscópicas previas que fracasaron. No hubo ninguna conversión a cirugía abierta. Hubo dos casos de perforación mucosa durante el procedimiento que fueron tratadas con éxito por vía laparoscópica. Diecinueve de las 21 unidades ureterales (90%) no presentaban RVU en el control mediante cistografía, y no se identificó disfunción vesical en el seguimiento. Conclusiones: La plastia laparoscópica de Gregoir-Lich es una alternativa factible, mínimamente invasiva para el RVU que reproduce el procedimiento abierto. Tiene un excelente porcentaje de éxitos y no se asocia con disfunción vesical, cruzó en procedimientos bilaterales (AU)

Lipoma de laringe: relato de um caso / Laryngeal lipoma: a case report

Menos de 100 casos de lipomas da laringe foram relatados na literatura. As manifestações clínicas típicas são disfagia, dispnéia e disfonia. Visualiza-se endoscopicamente uma massa, pediculada ou não, com baixa densidade na tomografia computadorizada. Ao exame anátomo-patológico revela-se um tumor composto de adipócitos maduros...

Fewer than 100 cases of laryngeal lipomas were reported. Typical clinical manifestations are dysphagia, dyspneia and hoarseness. We visualize endoscopically a mass, than can be pedunculated or not, with a low attenuation on computed tomography...

Carcinoma de paratireóide / Parathyroid carcinoma

O carcinoma de paratireóide uma neoplasia incomum. Corresponde a menos de 1 por cento dos casos de hiperparatireoidismo primário. Manifesta-se por hipercalcemia severa e mais de 50 por cento dos pacientes terão doença renal ou óssea concomitante...

Parathiroid carcinoma is a incommon malignancy. It accounts for less than one per cent of cases of primary hyperparathiroidism. It is manifested by severe hypercalcemia and up to 50 per cent of patients will have concomitant kidney or bone disease...