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.

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.

Laparoscopic resection of gastrointestinal stromal tumors (GIST) of the small intestine: a case report

Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest mesenchymal tumors of the gastrointestinal tract (GIT). GISTs can affect any segment of the GIT, but the usual location is the stomach, followed by the small intestine. Surgical resection of the tumor is the gold standard treatment for localized GISTs, and in patients with inoperable and metastatic disease, imatinib mesylate is the standard treatment. Pathological diagnosis is based on morphology and immunohistochemical findings. We report the case of a 55-year-old man with jejunal GIST presenting with endophytic and exophytic growth, located in the proximal jejunum. He had history of melena, anemia and one episode of enterorrhagia, and was treated with surgical resection of the lesion. (AU)

Ecological study of viral hepatitis in Brazil: a geographical and temporal analysis

Introduction: Viral hepatitis is a group of diseases that present high hepatotropism and are related to liver dysfunctions, having either an acute or a chronic course. Their worldwide epidemiology is diverse, with several endemic places, such as South America. The objective of this study was to analyze the epidemiology of viral hepatitis in Brazil, in order to better understand its pattern of distribution and evolution. Method: A temporal aggregation study was conducted using the Viral Hepatitis Database of the Brazilian Ministry of Health. The serological markers used were HBsAg and anti-HCV for hepatitis B and C, respectively. Mortality data were collected from the Mortality Information System for deaths attributed to viral hepatitis. The period analyzed was from 2007 to 2016/17. Results: The incidence was 7.88 (95% CI, 7.30-8.45) for hepatitis B and 11.9 (95% CI, 11.15-12.65) for hepatitis C. Mortality attributed to viral hepatitis was 1.61 (95% CI, 1.35-1.87) deaths per 100,000 people. An analysis of municipal distribution data showed several endemic areas. The Brazilian regions most affected by hepatitis B virus were the northern and southern borders, Santa Catarina coast and Espírito Santo state, while hepatitis C virus was mostly present in metropolitan areas such as Porto Alegre and São Paulo. Conclusions: Viral hepatitis has a diverse geographic distribution in the Brazilian territory, with highly endemic areas. The distribution differs between hepatitis B and hepatitis C viruses. (AU)

Reported mortality for colorectal cancer in Brazil in the first 16 years of the 21st century

Introduction: Colorectal cancer (CRC) is a malignant neoplasm with major impact on health today. There is, however, an efficient method for prevention and screening, which varies in different protocols according to each institution or country. The objective is to evaluate the mortality rate and the economic cost of CRC in Brazil during the first 16 years of the 21st century. Method: A retrospective, temporal aggregation study was conducted with an exploratory, documentary quantitative approach on CRC mortality from 2000 to 2016, based on the Mortality Information System database provided by the Brazilian Ministry of Health. Results: In the study period, 218,000 deaths due to CRC were recorded. The CRC mortality rate was 6.2 (95% confidence interval, 5.59-6.81) per 100,000 population, with no significant difference between men and women. Of the 17 age subgroups analyzed, eight had a significant increase from 2000 to 2016, including all subgroups aged over 50 years. Conclusion: There was an increase in mortality due to CRC in the study period.

Origen y trayecto anómalos del nervio musculocutáneo / Anomalus origin and traject of musculocutaneous nerve

El nervio musculocutáneo se origina del fascículo lateral en el plexo braquial y sus fibras emergen principalmente de las raíces nerviosas anteriores de C5 y C6. Durante la disección de rutina del plexo braquial en un cadáver formolizado, fue encontrada una variación del origen y trayecto de este nervio. El nervio musculocutáneo se originaba de la cara lateral del nervio mediano y después del origen, cruzaba anteriormente al músculo coracobraquial, sin perforarlo, de medial hacia lateral y de proximal hacia distal, para después ramificarse. Las variaciones anatómicas encontradas contribuyen para el estudio de la anatomía y sirven para el cirujano en intervenciones en la fosa axilar y en la parte anterior del brazo, previniendo, así, complicaciones operatorias.

The musculocutaneous is originated from the lateral fascicle in the brachial plexus and its fibers emerge mainly from the anterior nervous roots C5 and C6. During the routine dissection of the brachial plexus in a formolized corpse, its origin variation and passage was found. The nerve was originated on the lateral face of the median nerve and after its origin, crossed anteriorly to the coracobrachial muscle, without perforating it, from medial to lateral, proximal to distal, after to branch off. The anatomical variations found contribute to the anatomy study and they serve as alert for the surgeon in interventions in the axillary's cavity and in the previous store of the arm, preventing, thus, operational complications.

Heterotransplante hepático de primata näo humano neotropical para o homem. Existe a possibilidade técnica? / Hepatic heterotransplantation from neotropical non human primate to man. It is possible?

Um grande fator limitante ao desenvolvimento do transplante de fígado é a escassez de órgäos sendo realizados trabalhos na área do xenotransplante como alternativa a este entrave. Na Amazônia existe a maior biodiversidade de primatas näo humanos do planeta por conseguinte, verificou-se a factibilidade técnica da realizaçäo do heterotransplante hepático com uso de primata näo humano neotropical (PNHN). Realizou-se hepatectomia total em PNHN da espécie Cebus apella e utilizou-se este xenoenxerto em cadáver adulto para a realizaçäo da técnica operatória do heterotransplante ortotópico e do heterotransplante heterotópico auxiliar

Hemangioma do intestino delgado: relato de um caso / Hemangioma of the small bowel: a case report

A hemorragia digestiva pode representar um desafio diagnóstico, porque sua presentaçäo é, näo raro, insidiosa. O caso de um homem de 27 anos, com fezes pretas, em que os procedimentos diagnósticos efetuados antes da cirurgia foram insuficientes e enganadores, é apresentado. A literatura é revista e uma rotina de investigaçäo é sugerida

Hérnias incisionais: experiência com 61 casos / Incisional hernias: experience with 61 cases

Os autores apresentam sua experiência no manejo de 61 pacientes portadores de hérnia incisional, tratados no período de julho de 1979 a julho de 1986. É feita uma revisäo dos fatores que contribuem para o seu aparecimento e estabelecem a relaçäo entre o tipo de incisäo empregada e a incidência dessas hérnias. Realizam uma análise crítica sobre as várias possibilidades cirúrgicas para sua correçäo

Fístula esofágica cervical: uma forma de tratamento / Cervico esophageal fistula: a form of treatment

Os autores apresentam uma técnica de correçäo de fístulas esofágicas cervicais sem reintervençäo cirúrgica, baseados em sua experiência no tratamento de 20 casos. Realizam uma análise crítica comparativa entre o tratamento proposto e o comumente empregado em nosso meio