Hemopneumotórax recorrente: descrição da síndrome da endometriose torácica / Recurrent hemopneumothorax: thoracic endometriosis syndrome description

A endometriose torácica é uma forma de endometriose extrapélvica encontrada em tecidos pulmonares ou na pleura. Caracteriza- se clinicamente pela presença de pneumotórax catamenial, hemotórax catamenial, hemoptise e nódulos pulmonares. O pneumotórax catamenial é a manifestação mais frequente, sendo caracterizado pelo acúmulo recorrente de ar na cavidade torácica durante o período menstrual. Ocorre, geralmente, no hemitórax direito e possui maior incidência na faixa etária dos 30 aos 40 anos de idade. Nosso objetivo é descrever um caso de derrame pleural hemorrágico recorrente e pneumotórax espontâneo correlacionados ao período menstrual em paciente de 34 anos. (AU)

Thoracic endometriosis is a form of extrapelvic endometriosis found in pulmonary tissue or the pleura. Clinically, it is characterized by the presence of catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. The most frequent clinical presentation is catamenial pneumothorax, which is typified by a recurrent collection of air in the thoracic cavity occurring in conjunction with menstrual periods. It occurs more commonly on the right side and its highest incidence is between 30 and 40 years of age. Our objective is to describe a case of recurrent hemorrhagic pleural effusion and spontaneous pneumothorax correlated to the menstrual period in a 34-year-old patient. (AU)

Fatores preditores de malignidade em neoplasias de células de Hurthle / Predictor factors of malignancy in Hürthle cell neoplasms

OBJETIVO: neoplasias de células de Hurthle são tumores da glândula tireóide de baixa incidência que apresentam muitas controvérsias quanto à distinção entre carcinomas e adenomas. O objetivo deste estudo foi identificar fatores preditores de malignidade neste tipo específico de neoplasia. MÉTODOS: entre janeiro de 1999 e junho de 2006, 56 casos de neoplasia de células de Hurthle foram diagnosticados em nossa instituição e foram estudados retrospectivamente. RESULTADOS: trinta e sete pacientes apresentaram diagnóstico patológico de adenoma de células de Hurthle (ACH), enquanto 19 casos foram diagnosticados como carcinoma de células de Hurthle (CCH). No grupo de pacientes com adenomas a idade média foi de 47,8 anos, sendo que trinta e cinco (94 por cento) eram do sexo feminino e apenas dois (5,5 por cento) casos do sexo masculino. O tamanho médio dos adenomas foi de 2,1 cm variando de 0,3 a 6,0 cm. Entre os 19 casos de carcinomas a média de idade foi de 51,1 anos, sendo quatorze casos em mulheres (73 por cento) e cinco em homens (26,4 por cento). O tamanho médio dos nódulos neste grupo foi de 3,8 cm, variando de 2,0 cm a 7,5 cm. CONCLUSÃO: Pacientes com neoplasias de células de Hurthle apresentando nódulos maiores que três centímetros, principalmente em homens, apresentam maior risco de malignidade.

BACKGROUND: Hürthle cell neoplasms are uncommon thyroid gland tumors that present a diagnostic challenge due to difficulties to differentiate between adenomas and carcinomas. The purpose of this study is to identify preoperative predictor factors of malignancy. METHODS: A retrospective study of patients and tumor characteristics of 56 Hürthle cell tumors cases diagnosed in our institution between January 1999 and June 2006 was done. RESULTS: Thirty-seven patients presented with adenoma, 35 women (94.5 percent) and 2 men (4.5 percent) with average age of 47.8 years. Medium tumor size in this group was 2.1 cm (ranging from 0.3 to 6.0 cm). Nineteen patients with Hürthle cell carcinoma were found in this series with 14 (73 percent) female and 5 male patients with average age of 51.1 years. Tumor size in this group ranged between 2.0 and 7.5 cm (medium of 3.8 cm). CONCLUSION: Patients with Hürthle cell neoplasm nodules larger than 3.0 cm, in the greatest diameter, especially in male patients, are predictor factors of having malignancy.

Use of antibiotics without medical prescription.

UNLABELLED: The inappropriate use of antibiotics for the treatment of infections is a worldwide problem that has implications for the cost of treatment and the development of resistant strains of bacteria. The use of antibiotics should follow specific criteria; they are on top of the list of self-medication drugs in countries that do not control their commercialization. OBJECTIVES: To determine the percentage of pharmacies that attend the public and sell antibiotics without medical prescription in a medium-sized city in Brazil, and analyze the variables involved in this procedure. MATERIALS AND METHODS: 107 of the 136 pharmacies registered in our city were evaluated. These pharmacies were visited by actresses who simulated having a sister with symptoms of a non-complicated rhino-sinusitis, so that they could obtain antibiotics without a medical prescription. Each pharmacy was visited only once; the only variable in the simulated clinical setting was the report of fever temperature, which was randomly assigned between 38.5 and 40 degrees Celsius. RESULTS: Antibiotics were offered in 58% of the pharmacies, and this offer was increased to 74% after the actresses insisted on having them. In 65.4% of the pharmacies, the actresses were attended by a pharmacist, and 84.2% of them said they would sell antibiotics. When the request for antibiotics was denied (26%), only 7.5% was due to absence of prescription. The most frequent reason for refusal to sell antibiotics, was because the attendant deemed it unnecessary (46.6%) CONCLUSION: Antibiotics can be easily bought in the great majority of the pharmacies in our town without a medical prescription and a clear indication. Fever temperature did not modify the attendant's indication of the drug.

Use of antibiotics without medical prescription

The inappropriate use of antibiotics for the treatment of infections is a worldwide problem that has implications for the cost of treatment and the development of resistant strains of bacteria. The use of antibiotics should follow specific criteria; they are on top of the list of self-medication drugs in countries that do not control their commercialization. OBJECTIVES: To determine the percentage of pharmacies that attend the public and sell antibiotics without medical prescription in a medium-sized city in Brazil, and analyze the variables involved in this procedure. MATERIALS AND METHODS: 107 of the 136 pharmacies registered in our city were evaluated. These pharmacies were visited by actresses who simulated having a sister with symptoms of a non-complicated rhino-sinusitis, so that they could obtain antibiotics without a medical prescription. Each pharmacy was visited only once; the only variable in the simulated clinical setting was the report of fever temperature, which was randomly assigned between 38.5 and 40 degrees Celsius. RESULTS: Antibiotics were offered in 58 percent of the pharmacies, and this offer was increased to 74 percent after the actresses insisted on having them. In 65.4 percent of the pharmacies, the actresses were attended by a pharmacist, and 84.2 percent of them said they would sell antibiotics. When the request for antibiotics was denied (26 percent), only 7.5 percent was due to absence of prescription. The most frequent reason for refusal to sell antibiotics, was because the attendant deemed it unnecessary (46.6 percent) CONCLUSION: Antibiotics can be easily bought in the great majority of the pharmacies in our town without a medical prescription and a clear indication. Fever temperature did not modify the attendant's indication of the drug.

Post-pneumonectomy chylothorax

Postoperative chylothorax is an unusual complication following thoracic surgical procedures. Treatment of this complication remains controversial. The authors present a case of left sided chylothorax following a left pneumonectomy which was successfully treated in a conservative manner. The rationale for conservative treatment in this case as well as a review of the literature are provided.

Adenoma de glândulas mucosas do brônquio / Mucous gland adenoma of the bronchus

É relatado um caso de adenoma de glândulas mucosas do brônquio em homem de vinte anos de idade e feita breve revisäo da literatura. Essa neoplasia era classificada no grupo dos adenomas brônquicos, um grupo heterogêneo de neoplasias, composto por tumores de baixo grau de malignidade. De acordo com a atual classificaçäo da OMS ela é estudada separadamente, sendo uma forma muito rara de neoplasia benigna

Tempo de coagulaçäo ativado em cirurgia cardíaca com circulaçäo extracorpórea / Coagulation time in heart surgery with extracorporeal circulation

Muitos trabalhos tem sido publicados sobre o controle do sangramento durante a circulaçäo extracorpórea em pacientes submetidos a cirurgia cardíaca. O uso de protocolos rígidos de anticoagulaçäo apresentam inconvenientes, pois näo levam em consideraçäo a sensibilidade individual dos pacientes à heparina. A técnica para determinar o Tempo de Coagulaçäo Ativado pelo celite foi descrita em 1966 e introduzida posteriormente em cirurgia cardíaca em 1975, determinando um grande progresso no controle da anticoagulaçäo em circulaçäo extracorpórea que pode ser evidenciado pela diminuiçäo das complicaçöes hemorrágicas no trans e pós-operatório. O objetivo de nosso trabalho foi o de avaliar a rotina de heparinizaçäo empregada nos pacientes submetidos à cirurgia cardíaca com circulaçäo extracorpórea no HUSM. Observamos que, apesar do TCA manter-se em níveis adequados durante a perfusäo, houve grande variaçäo em seus valores, demonstrando diferente sensibilidade dos pacientes à heparina