Manifestações neurológicas da doença de Behçet / Neurological features of Behçet's disease

Introdução: A doença de Behçet (DB), também chamada síndrome de Behçet, é uma doença crônica, multissistêmica com remissões e exacerbações e evolução imprevisível. Objetivo: Descrever as manifestações neurológicas da doença de Behçet. Metodologia: Revisão narrativa da literatura utilizando o Pubmed como banco de dados. Resultados: Envolvimento neurológico em pacientes com DB conhecido como Neuro-Behcet (NB) apresenta uma prevalência variável de 2.2-5%. O diagnóstico de NB e baseado na presença de síndromes neurológicas em pacientes com achados sistêmicos de DB. Achados de neuroimagem e achados de líquor são uteis para excluir diagnósticos diferenciais, principalmente quadros infecciosos. Conclusão: Ainda que a DB seja rara na pratica neurológica rotineira, esta e comumente mencionada no diagnostico diferencial de doenças inflamatórias e/ou desmielinizantes do SNC.

Introductino: Behçet's disease (BD), also called Behçet's syndrome, is a chronic, multisystemic disease with remissions and exacerbations and unpredictable evolution. Objective: To describe neurological manifestations of BD. Metodology: Narrative review of the literature using Pubmed database. Results: Neurological involvement in patients with BD known as Neuro-Behcet (NB) has a variable prevalence of 2.2-5%. The diagnosis of NB is based on the presence of neurological syndromes in patients with systemic BD findings. Neuroimaging findings and cerebrospinal fluid findings are useful to exclude deferential diagnoses, especially infectious conditions. Conclusion: Although BD is rare in routine neurological practice, it is commonly mentioned in the differential diagnosis of inflammatory and / or demyelinating diseases of the CNS.

Tobacco and Alcohol Use and Clinical Staging of Head and Neck Tumors

Abstract Objective: To determine the relationship between tobacco and alcohol consumption and staging of head and neck cancer in patients treated at a referral hospital for cancer treatment. Material and Methods: This is a cross-sectional study based on medical records of patients with head and neck cancer treated between 2008 and 2015. The following variables were considered: gender, age, marital status, educational level, place of residence, profession, affected site, clinical staging of neoplasms, histopathological diagnosis, tobacco and alcohol consumption. Results: Of the 154 medical records analyzed, there was a predominance of male patients (72.7%), single (50%), with low education (88.1%), rural workers (38.3%), residents in the state countryside (70.2%) and aged 20-94 years. T3 and T4 size tumors prevailed. A significant correlation was found between alcohol use and tumor size (p=0.03) and presence of nodules (p<0.001), as well as between alcohol use and smoking with tumor size (p=0.04) and presence of nodules (p=0.019). No correlations were observed between tobacco use and injury staging. Conclusion: There was strong significance between tumor size and presence of nodules, both with the use of alcohol alone and with tobacco, thus suggesting the existence of important carcinogenic action of this substance.

Sarcoidosis of the breast: an unusual clinical presentation / Sarcoidosis da mama: uma apresentação clinica não usual

Introduction: sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. The breast may be involved in less than 1% of cases and often mimics carcinomas at clinical examination. Case report: herein, the authors report a 54-year-old woman who had history of erythema nodosum, had clinical presentation suggestive of mastalgia whose mammography and ultrasound showed bilateral unspecific heterogeneous parenchymal densities. Histopathological study revealed non-caseous giant cell granulomas. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated and a CT scan showed small bilateral pulmonary nodules distributed along the pleura and bronchovascular bundles (perilymphatic pattern), however without enlarged bilateral hilar and mediastinal lymph nodes. The patient was treated with prednisolone and methotrexate, and is currently asymptomatic. Conclusion: breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast.

Introdução: a sarcoidose é uma doença granulomatosa sistêmica crônica de etiologia desconhecida. A mama pode ser envolvida em menos de 1% dos casos e, muitas vezes, imita os carcinomas ao exame clínico. Relato de caso: aqui, os autores relatam uma mulher de 54 anos que teve história de eritema nodoso, apresentou quadro clinico sugestivo de mastalgia, cuja mamografia e ultra-som apresentaram densidades parenquimatosas heterogêneas inespecíficas bilaterais. O estudo histopatológico revelou granulomas de células gigantes não-caseosos. Especificamente, os níveis séricos de enzima conversora de angiotensina (ECA) estavam elevados e uma TC apresentou pequenos nódulos pulmonares bilaterais distribuídos ao longo da pleura e feixes broncovasculares (padrão perilinfático), porém sem gânglios bilaterais hilar e mediastinal. A paciente foi tratado com prednisolona e metotrexato, e atualmente está assintomática. Conclusão: o envolvimento mamário por sarcoidose, embora raro, deve ser considerado ao lidar com lesões granulomatosas da mama.