Paracoccidioidomycosis and Addison's syndrome - case report.

Paracoccidioidomycosis is caused by a fungus (Paracoccidioides brasiliensis), which is endemic to Brazil. It is most frequently found in the lungs, with haematogenous and lymphatic spread. The condition is more prevalent in men, between 30 and 60 years old, commonly rural workers. It is the third leading cause of death among chronic infectious diseases today. The systemic disease has an insidious and nonspecific course, with adrenal involvement being observed in 5% of cases and requiring the destruction of 80% of the glands for symptoms of adrenal insufficiency to appear. Isolated involvement of this gland is quite rare. In this case report, however, our patient presented wasting and adrenal insufficiency with isolated adrenal involvement by the fungus.

EARLY INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION: RISK FACTORS AND HERNIA REPAIR RESULTS.

BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p<0.001) were risk factors for IH. In all, 28 (39.4%) patients were submitted for hernia repair with mesh, with a recurrence rate of 17.8%. CONCLUSION: Incisional hernia after liver transplantation is a relatively common problem associated with male gender, diabetes, and acute cellular rejection. This is a problem that should not be trivialized in view of the complexity of liver transplantation, as it can lead to a reduction in quality of life as well as jeopardize late liver transplantation results and lead to incarceration and strangulation.

Cotite Apendicular - Relato de Caso / Stump appendicitis - Case Report

Cotite apendicular é uma rara complicação pós-apendicectomia, que se caracteriza por ser uma inflamação do coto apendicular remanescente devido à obstrução do seu lúmen, geralmente por um fecalito. Isso aumenta a pressão intraluminal, prejudica a drenagem venosa e facilita subsequente infecção bacteriana. Em virtude da baixa incidência desta patologia, seu diagnóstico costuma ser tardio, podendo gerar consequências deletérias ao paciente. Os achados clínicos e radiológicos são semelhantes aos da apencidite aguda, e o tratamento é a reintervenção cirúrgica e complementação da apendicectomia, excisando o coto remanescente.

Stump appendicitis is a rare post-appendectomy complication characterized as an inflammation of the remaining appendicular stump due to obstruction of its lumen, usually by a fecalith. Which increases intraluminal pressure, impairs venous drainage, and facilitates subsequent bacterial infection. Due to the low incidence of this pathology, its diagnosis is usually late, and it can have deleterious consequences for the patient. The clinical and radiological findings are similar to those of acute appendicitis, and the treatment is surgical reintervention and complementary appendectomy, excising the remaining stump.

Perfil dos pacientes operados por adenoma hepático em serviço de cirurgia hepatobiliar do Rio Grande do Sul / Profile of patients who underwent operation for liver adenoma in an hepatobiliary surgery service in Rio Grande do Sul

Introdução: O trabalho objetiva avaliar o perfil epidemiológico dos pacientes operados por adenoma hepático e os fatores de influência nas diferentes apresentações clínicas. Métodos: Estudo transversal descritivo com 21 pacientes operados por adenoma hepático. Dados de prontuário e laudos anatomopatológicos foram revisados a fim de estudar a relação entre perfil dos pacientes, apresentação clínica e características do tumor. Resultados: Sexo feminino foi predominante na amostra. A idade média dos pacientes foi de 32 anos e o IMC médio 25,9. Uso de anticoncepcional oral foi relatado em 93% dos casos, sendo 13 anos o tempo médio de uso. A presença de comorbidades teve associação com adenomas de maior tamanho, e diabetes mellitus foi doença mais frequente associada a este tumor. Houve associação clínica entre tamanho do adenoma e sintomatologia: pacientes com sinais e sintomas mais pronunciados apresentaram lesões de tamanho médio superior em comparação aos pacientes com sintomas inespecíficos ou ausentes. Conclusão: Os fatores já conhecidos associados ao Adenoma Hepático envolvem o sexo feminino, uso de contraceptivo oral de longa data, doenças do armazenamento do glicogênio, uso de anabolizantes e, menos comumente, gestação e diabetes mellitus. Neste trabalho evidenciamos o diabetes mellitus como a comorbidade mais frequente entre os pacientes com diagnóstico de Adenoma Hepático, relacionando-se a adenomas de maior tamanho na amostra deste estudo, o que sugere possível associação do diabetes mellitus na gênese dos adenomas hepáticos e também no prognóstico, visto que lesões maiores representam risco aumentado de complicações.

Introduction: This work aims to evaluate the epidemiological profile of patients who underwent surgery for liver adenoma and the factors that could influence different clinical presentations. Methods: Descriptive cross-sectional study with 21 patients with liver adenoma who underwent surgery. Medical records and pathological reports were reviewed to study the connection between patients' profile, clinical presentation, and features of the tumor. Results: Female sex predominated in the sample. The mean age of patients was 32 years and the mean BMI was 25.9. The use of oral contraceptives was reported in 93% of the cases, with an average usage time of 13 years. The presence of comorbidities was associated with larger adenomas, and diabetes mellitus was the most frequent comorbidity co-existing with this tumor. Clinical association between the size of adenomas and symptoms was identified: patients with more pronounced signs and symptoms had larger lesions compared with patients with nonspecific or absent symptoms. Conclusion: The known factors associated with Hepatic Adenoma involve female sex, long-term use of oral contraceptives, glycogen storage diseases, use of anabolic steroids, and, less commonly, pregnancy and diabetes mellitus. In this study, we highlight diabetes mellitus as the most frequent comorbidity among patients diagnosed with Hepatic Adenoma, relating to larger adenomas in this study sample, which suggests a possible association of diabetes mellitus in the genesis of liver adenomas and in the prognosis, since larger lesions represent an increased risk of complications.

Fascíola hepática: relato de caso / Fasciola hepatica: case study

As síndromes consumptivas possuem ampla variedade de diagnósticos diferenciais, sendo um desafio na prática médica. Neste relato, a paciente apresentou astenia, diarreia e tosse, evoluindo com dor em hipocôndrio direito. A elucidação adveio da análise histopatológica após a primeira suspeição ser de lesão hepática maligna. Como desfecho, a infecção pelo trematódeo Fasciola hepatica, endêmico de clima temperado, foi a causa etiopatogênica. Nesse sentido, a intenção deste relato é trazer para discussão diagnósticos diferenciais de síndrome consumptiva tendo em vista etiologias endêmicas.

Consumptive syndromes have an ample variety of differential diagnoses and are a challenge in the medical practice. In this report, the patient presented asthenia, diarrhea, and cough, evolving to pain in the right hypochondrium. The elucidation came from the histopathological analysis after the first suspicion of it being a malignant hepatic lesion. The outcome, infection by the trematode Fasciola hepatica, endemic of temperate climate, was the etiopathogenic cause. In this sense, this report aims to discuss differential diagnostics of consumptive syndrome considering endemic etiologies.

Early incisional hernia after liver transplantation: risk factors and hernia repair results / Hérnia incisional precoce após transplante hepático: fatores de risco e resultados do reparo cirúrgico

ABSTRACT BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p<0.001) were risk factors for IH. In all, 28 (39.4%) patients were submitted for hernia repair with mesh, with a recurrence rate of 17.8%. CONCLUSION: Incisional hernia after liver transplantation is a relatively common problem associated with male gender, diabetes, and acute cellular rejection. This is a problem that should not be trivialized in view of the complexity of liver transplantation, as it can lead to a reduction in quality of life as well as jeopardize late liver transplantation results and lead to incarceration and strangulation.

RESUMO RACIONAL: O transplante de fígado é uma terapia complexa e valiosa. Entretanto, complicações que prejudicam a qualidade de vida pós-operatória, como a hérnia incisional, devem ser mais bem elucidadas, analisando os fatores de risco e medidas profiláticas. OBJETIVOS: Definir a taxa de hérnia incisional em pacientes submetidos a transplante de fígado em uma população do sul do Brasil, avaliar os fatores de risco relacionados, a fim de estabelecer futuramente medidas de otimização prévia e cuidados profiláticos específicos. MÉTODOS: Foram analisados, retrospectivamente, pacientes submetidos a transplante de fígado adultos, de janeiro de 2004 a novembro de 2020, avaliando suas características demográficas, resultados cirúrgicos e fatores predisponentes. RESULTADOS: Dentre os 261 pacientes transplantados hepáticos incluídos, a hérnia incisional foi diagnosticada em 71 (27,2%). Vinte e oito do total de 71 pacientes com hérnia incisional (39,4%) desenvolveram hérnia incisional durante o primeiro ano pós-transplante. A maioria era do sexo masculino [n=52, (73,2%)]; 52/71 (73,2%) apresentavam cirrose secundária ao vírus da hepatite C; 33/72 (46,5%) foram portadores de carcinoma hepatocelular. Sexo masculino (p=0,044), diabetes mellitus (p=0,008) e rejeição celular aguda (p<0,001) foram fatores de risco estatisticamente significantes para hérnia incisional. Vinte e oito pacientes (39,4%) foram submetidos à hernioplastia incisional com tela, com taxa de recidiva de 17,8%. CONCLUSÕES: Hérnia incisional após transplante de fígado é um problema relativamente comum, associado ao sexo masculino, diabetes e também a rejeição celular aguda. Este é um problema que não deve ser banalizado, já que pode levar à redução da qualidade de vida, comprometer os resultados tardios do transplante de fígado e pode levar a encarceramento ou estrangulamento.