Clinical relevance of gallbladder wall thickening for dengue severity: A cross-sectional study.

Dengue fever is the most important arthropod-borne viral infection worldwide. Secondary prevention to reduce mortality through improved clinical case management has substantially lowered the mortality rate for severe dengue during the past two decades. Gallbladder wall thickening (GBWT) is a nonspecific finding often associated with more severe cases of dengue infection. This study had the aim to describe the ultrasonographic findings in hospitalized patients with dengue infection from Manaus (in the Western Brazilian Amazon) and to correlate the GBWT with dengue severity, symptoms and laboratorial analysis. Patients from 13-84 years admitted to the emergency department at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) were enrolled in this study. Patients' selection occurred during the most recent and huge dengue outbreak within the first semester of 2011. All enrolled subjects were systematically tested in order to rule out other possible etiologies for gallbladder inflammation. Abdominal ultrasound was performed by a single physician through bedside portable equipment and all other clinical and laboratorial information were retrieved from patients' electronic files. 54 subjects were considered for analysis, with confirmed dengue infection by NS1 and/or RT-PCR positivity. From all enrolled patients, 50 (42.4%) presented GBWT. GBWT was significantly and independently related to: age under 31 years, pregnancy, presence of bleeding, presence of any cavitary effusion, DHF classification and severe dengue classifications. During dengue outbreaks, the GBWT identification through a non-invasive and bedside procedure is a confident marker for prompt recognition of potential severe cases.

Cerebelite aguda por Cryptococcus em paciente imunocompetente. Relato de caso / Acute cerebellitis caused by Cryptococcus in an immunocompetent patient. Case report

A cerebelite aguda é uma condição neurológica que pode ocorrer principalmente em associação à infecção viral, bem como a outros agentes infecciosos. A criptococose cerebral é a infecção que ocorre mais comumente em pacientes imunossuprimidos, principalmente na forma de meningoencefalite. O objetivo deste estudo foi relatar um caso de cerebelite fúngica em paciente imunocompetente, condição não relatada na literatura até omomento. Paciente do gênero masculino, 30 anos, foi encaminhado para investigação de quadro agudo de náuseas, vômitos, cefaleia intensa, vertigem e ataxia da marcha. A ressonância nuclear magnética de encéfalo demonstrou imagem hipodensaisolada em cerebelo. A análise liquórica evidenciou Criptococcus em fase de gemulação. Houve melhora completa do quadro após tratamento com anfotericina B e fluconazol. A infecção fúngica por Criptococcus é condição incomum em pacientes imunocompetentes. Casos previamente relatados de criptococose não seapresentaram de forma isolada em cerebelo. De acordo com o presente estudo, quando o quadro clínico do paciente for compatível com cerebelite, é importante atentar para outras possibilidades etiológicas, que não apenas vírus ou bactérias...

Acute cerebellitis is a neurological condition that can occur especially in association with viral infection, as well as other infectious agents. Cerebral criptococcose infection most commonly occurs in immunosuppressed patients, mainly in the form of meningoencephalitis. The objective of this study was to report a case of fungal cerebellitis in an immunocompetentpatient, a condition not reported in the literature. Male patient, 30 years old, was referred for investigation of acutenausea, vomiting, severe headache, vertigo and gait ataxia. The magnetic resonance of the brain showed an isolated hypodense image in cerebellum. The analysis of the cerebral spinal fluidrevealed cryptococcus in the process of budding. There was complete improvement after treatment with anphotericin B and fluconazole. The fungal infection cryptococcus is an uncommon condition in immunocompetent patients. Previously reported cases of criptococcose were not presented in isolation in thecerebellum. According to this study, when the patient’s condition is compatible with cerebellitis, it is important to pay attention to other etiological possibilities, not just viruses or bacteria...

Urgências e emergências em neurorradiologia. / Neuroradiology urgencies and emergencies.

Objetivo: analisar os pacientes submetidos à TC (tomografia computadorizada) em uma clínicaparticular em Manaus AM. Método: abordar pacientes atendidos na urgência que realizaram TCde crânio no horário de sobreaviso, período de outubro/2007 a setembro/2008. Resultados:foram 144 pacientes, 60 do sexo masculino e 84 feminino; 66 não apresentaram achados de TCEou AVC; os traumatizados foram 20. Em relação aos acidentes vasculares, 22 recentes, 15isquêmicos, 02 hemorrágicos e 56 tardios. Discussão: em função da TC de crânio estar disponívele relativa boa sensibilidade, tem se tornado a técnica de escolha para rastreamento de AVCs etraumatismos. Conclusão: os exames de imagem, incluindo a TC são de extrema importânciapara o auxílio na conduta.

Objective: neuroradiology urgencies and emergencies in a private clinic at Manaus, state ofAmazonas are common and include strokes, head trauma, infecctions diseases and less commontumoral processes. This study has the objective of analyse the patients that were submitted tocomputed tomography scan (CT) at Sensumed Clinic. Methods: there were realizedretrospectively every patient that made CT scan during extra time from October 2007 untilSeptember 2008. Results: there were 144 patients, 60 male and 84 female. 66 patients did nothave any radiologic finding for head trauma or stroke. The trauma patients were 20. The strokeswere 22 recent events, including 15 ischemic, 02 hemorragic and 56 late findings. Discussion: asCT scan is a disponible and with relatively good sensibility exam comparing to other exams, thisis the choice for screening at urgencies. Conclusion: we conclude that imaging findings areextremely important for medical conduct.

[Radiological aspects of primary tuberculosis in the breast: a case report and review of the literature]. / Aspectos radiológicos da tuberculose primária da mama: relato de caso e revisão de literatura.

Mammary tuberculosis is an illness accounting for less than 0.1% of breast lesions. We present a case from our service and discuss the radiological findings from mammography, ultrasound scan and magnetic resonance, including kinetic curves. Mammary tuberculosis is an unusual condition and such reports are important in relation to the differential diagnoses versus breast cancer and pyogenic abscess.

Aspectos radiológicos da tuberculose primária da mama: relato de caso e revisão de literatura / Radiological aspects of primary tuberculosis in the breast: a case report and review of the literature

A tuberculose mamária é uma enfermidade equivalente a menos que 0,1 por cento das lesões deste órgão. Apresentamos a seguir um caso de nosso serviço discutindo os achados radiológicos da mamografia, ultrassonografia e ressonância magnética, incluindo curvas cinéticas. A tuberculose mamária é uma condição ímpar, sendo importante o relato pelos diagnósticos diferenciais com carcinoma mamário e o abscesso piogênico.

Mammary tuberculosis is an illness accounting for less than 0.1 percent of breast lesions. We present a case from our service and discuss the radiological findings from mammography, ultrasound scan and magnetic resonance, including kinetic curves. Mammary tuberculosis is an unusual condition and such reports are important in relation to the differential diagnoses versus breast cancer and pyogenic abscess.