Posterior urethral valve in fetuses: evidence for the role of inflammatory molecules.

BACKGROUND: The aim of this cross-sectional study was to investigate inflammatory biomarkers in urine samples of 24 fetuses with posterior urethral valve (PUV) collected at 22 ± 4 weeks of gestation and to compare the findings with measurements in urine samples of 22 male healthy preterm neonates at 23 ± 4 weeks (control group). METHODS: Inflammatory biomarkers in urine were measured using a cytometric bead array [interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ, soluable tumor necrosis factor receptor (TNFR) 1, sTNFR2, monocyte chemoattractant protein-1/chemokine ligand 2 (MCP-1/CCL2), eotaxin/CCL11 and interferon gamma-induced protein/10/C-X-C motif chemokine 10 (IP-10/CXCL10)] and ELISA assays [TNF, IL-8/CXCL8 and transforming growth factor-beta (TGF-ß)]. The Mann-Whitney test was used to compare medians. Markers of glomerular (creatinine) and tubular [beta 2 (ß2)-microglobulin, uromodulin, osmolality] functions were correlated with inflammatory biomarkers (Spearman test). RESULTS: An intense inflammatory profile was identified, with significantly increased concentrations of urinary IL-2, IL-4, IL-6, TNF, sTNFRI, sTNFRII, IFN-γ, MCP-1/CCL2, eotaxin/CCL11 and IL-8/CXCL8 in the PUV group compared to the controls. The same was observed for the anti-inflammatory cytokine IL-10 and for the fibrogenic mediator TGF-ß. In the correlation analysis, ß2-microglobulin positively correlated with the presence of MCP-1/CCL2, sTNFRI and eotaxin/CCL11 and negatively correlated with the presence of creatinine. CONCLUSIONS: This study shows that inflammatory molecules are already increased in fetuses with PUV at the mean gestational age of 22 weeks, suggesting a physiopathological role for inflammation just after the embryological formation of the urethral membrane.

Prenatal diagnosis of congenital syngnathia by 3D ultrasound and pathological correlation.

Congenital syngnathia is a maxillomandibular fusion, and it can vary in severity from single mucosal bands (synechiae) to complete bony fusion (synostosis). Cases of combinations of bony or soft tissue adhesions between the mandible and maxilla with cleft of the lip or palate, aglossia, popliteal pterygium, and van der Woude syndrome have been reported. It is a very rare condition, with only one case report of prenatal diagnosis using two-dimensional ultrasound in the literature. We present the first case of prenatal diagnosis of congenital syngnathia by three-dimensional ultrasound and the postnatal pathology correlation.

The use and role of telemedicine in maternal fetal medicine around the world: an up-to-date.

Purpose: The aim of this narrative review is to sumarize data about the use and role of telemedicine in maternal fetal medicine (MFM). Methods: We searched pubmed and scopus to find articles about telemedicine in MFM by using the terms telmedicine or telehealth and maternal fetal medicine. Results: Telehealth has been widely used for several medical specialties. During the coronavirus disease 2019 (COVID-19) pandemic, telehealth has gained investment and further research. Even though telemedicine in MFM has not been frequently applied, from 2020 onwards it has increased in both implementation and acceptance worldwide. The need to screen the patients in overloaded centers in a pandemic scenario required telemedicine in MFM, which has exhibited consistently good results concerning health and budget. The aim of this study was to review the telehealth programs and research focused on MFM around the world. Few studies have been applied to MFM and even fewer in developing and undeveloped countries. The majority of studies were concentrated in the USA and in Europe. Conclusion: Further research is needed, especially in non-developed countries, to comprehend the potential role of telemedicine in MFM for improving the life quality of the patients, health professionals, and to be cost-efficient.

Roux-en-Y gastric bypass pouch outlet reduction using argon plasma coagulation to treat weight regain: a randomized controlled trial with a sham control group.

Background and study aims A comparative study was conducted to evaluate the efficacy of argon plasma coagulation (APC) therapy in treating post Roux-en-Y gastric bypass (RYGB) weight regain and the incidence of complications related to this procedure, using a sham treatment group as a control. Patients and methods Forty-one patients with a minimum weight regain of 10 kg and a minimum postoperative time of 36 months were randomized into two groups. Results In the APC group (n = 21), the mean initial weight was 100.4 kg and the mean weight regain was 24.94 kg. In the sham group (n = 20), the mean initial weight was 103.65 kg, and the mean weight regain was 25.18 kg. Anastomotic stenosis occurred only after the first APC session. The results for the comparison of APC with the sham group showed a percentage weight regain loss of 63.95 compared to -.65, and weight loss of 15.02 and -0.57), percentage total weight loss of 14.46 and -0.62, excess weight loss of 54.32 % and -2.34 %), and BMI reduction of 5.38 and -0.21, with P  < 0.0001 for all the comparisons. In the APC group, there was a significant reduction in HbA1c (5.66 % to 4.96 %) and triglycerides (153.20 mg/dL to 132.20 mg/dL). Conclusions This study indicates that APC outlet pouch reduction outperforms sham treatment in terms of weight loss for patients presenting weight regain after RYGB.

Tubular and glomerular biomarkers of renal tissue function in the urine of fetuses with posterior urethral valves.

INTRODUCTION: Posterior urethral valve (PUV) is a congenital malformation characterized by a membranous structure located in the prostatic portion of the male posterior urethra that obstructs the urinary flow. Efforts have been made to determine the degree of impairment of fetal kidney function in this condition. OBJECTIVE: This study aimed to measure the levels of urinary biomarkers of glomerular and tubular functions in fetuses with PUV and to compare with the levels of the same molecules in healthy male premature newborns. STUDY DESIGN: Urine samples from 43 fetuses with PUVs were collected and compared with urine samples from 40 healthy male newborns of the same gestational age (controls). Tubular and glomerular biomarkers levels were measured in urine samples by MILLIPLEX® assay kits. Levels of the molecules were related to creatinine (Cr) measurements at same urine samples and expressed as pg/mg Cr. Results were analysed with Graphpad Prism version 7.0 and SPSS version 20.0. RESULTS: Fetuses with PUV showed a significant reduction in urine levels of Epidermal Growth Factor (EGF), Calbindin, Osteoactivin, Molecule Renal Injury 1 (KIM-1 and Factor of trefoil 3 (TFF-3) when compared to controls. On the other hand, urine levels of cystatin C and renin were higher in PUV fetuses. The levels of molecules also differed according to urine osmolality and grade of hydronephrosis. DISCUSSION: Some urinary excreted molecules may indicate kidney damage in several segments along the nephron, while others may exert important functions. Mechanical and immunological mechanisms related to PUV might significantly modulate the synthesis of cytokines related to glomerular and tubular physiology, leading to alterations in urinary concentrations of those molecules. These biomarkers can be used as future diagnostic and prognostic markers in clinical practice. CONCLUSION: Early kidney structural and functional impairment influenced the synthesis of glomerular and tubular molecules related to kidney physiological processes in fetuses with PUV.

Birnbaum-Saunders sample selection model.

The sample selection bias problem occurs when the outcome of interest is only observed according to some selection rule, where there is a dependence structure between the outcome and the selection rule. In a pioneering work, J. Heckman proposed a sample selection model based on a bivariate normal distribution for dealing with this problem. Due to the non-robustness of the normal distribution, many alternatives have been introduced in the literature by assuming extensions of the normal distribution like the Student-t and skew-normal models. One common limitation of the existent sample selection models is that they require a transformation of the outcome of interest, which is common R + -valued, such as income and wage. With this, data are analyzed on a non-original scale which complicates the interpretation of the parameters. In this paper, we propose a sample selection model based on the bivariate Birnbaum-Saunders distribution, which has the same number of parameters that the classical Heckman model. Further, our associated outcome equation is R + -valued. We discuss estimation by maximum likelihood and present some Monte Carlo simulation studies. An empirical application to the ambulatory expenditures data from the 2001 Medical Expenditure Panel Survey is presented.

Randomized Prospective Clinical Study of Spatz3® Adjustable Intragastric Balloon Treatment with a Control Group: a Large-Scale Brazilian Experiment.

BACKGROUND: To analyze the results regarding weight loss and complications related to the Spatz3® adjustable intragastric balloon (IGB) in Brazil. METHODS: This randomized prospective study covered patients who had undergone treatment using a Spatz3® adjustable IGB between October 2016 and June 2018 at a private clinic in Rio de Janeiro, Brazil. The patients had a minimum body mass index (BMI) of 27 kg/m2. The study examined complications of Spatz3® treatment and BMI reduction, percentage of total weight loss (%TWL), and % of excess weight loss (%EWL). RESULTS: One hundred eighty patients underwent a Spatz3® balloon implant in the period. The patients were randomly divided into one group in which the Spatz balloon was kept at the same volume (600 mL) throughout treatment (Control Group), and another adjustment group with 250 mL greater volume. The complication rate was 16.14%. No death or major complication occurred during the study. Mean BMI decreased from 39.51 to 32.84 kg/m2 (p < 0.0001), bodyweight from 111.87 to 90.28 kg (p < 0.0001), and excess weight from 41.55 to 22.99 kg (p < 0.0001). The adjustment resulted in greater mean weight loss of 4.35 kg (- 8 to 17.6 kg), and the average time of the procedure was 7.12 ± 1.63 months. The upward adjustment group did not present greater %TWL, %EWL, or BMI reduction when compared with the control group (p = 0.4413, p = 0,9245, p = 0.2729, respectively). CONCLUSION: This study shows that Spatz3® IGB treatment is an effective procedure for weight reduction, with no mortality but higher morbidity compared with traditional IGBs. This procedure also enabled the balloon to stay in place for longer. The efficacy of upward adjustment still requires further confirmation.

Intragastric Balloon: a Retrospective Evaluation of 5874 Patients on Tolerance, Complications, and Efficacy in Different Degrees of Overweight.

BACKGROUND: Endoscopic methods, especially the intragastric balloon (IGB), have been shown to be effective for the treatment of excess weight. This study aimed to assess the tolerance, complications, and efficacy of excess weight treatment with a non-adjustable IGB during 6 months. METHODS: A total of 5874 patients treated with a liquid-filled IGB (600-700 mL) and followed up by a multidisciplinary team were evaluated. Participants presented an initial body mass index (BMI) ≥ 25 kg/m2 and were stratified according to sex and degree of overweight (overweight and obesity grades I, II, and III). RESULTS: The incidence of complications was 7.32% (n = 430): 6.10% (n = 357) early IGB removal, 0.20% (n = 12) gas production inside the balloon, 0.54% (n = 32) leakage, 0.32% (n = 19) pregnancy, 0.07% (n = 4) gastric perforation, 0.05% (n = 3) upper digestive bleeding, 0.01% (n = 1) Wernicke-Korsakoff syndrome due to excessive vomiting, and 0.02% each (n = 1) pancreatitis and esophagus perforation. The 5444 remaining patients (4081 women, 38 ± 38 years) presented a weight loss of 19.13 ± 8.86 kg and a BMI decreased significantly (p < 0.0001) (36.94 ± 5.67 vs. 30.08 ± 5.06 kg/m2). The % total weight loss (%TWL) was 18.42 ± 7.25%, and the % excess weight loss (%EWL) was 65.66 ± 36.24%. The treatment success rate (%TWL ≥ 10%) was 85%. The %EWL was higher in the pre-obese group (122.19%), followed by obesity grades I (76.67%), II (56.01%), and III (45.45%), with p < 0.0001 for each group. %EWL was higher in women (69.71%) than in men (53.39), with p < 0.0001 for each group. There was also a statistical difference between the TWL and EWL groups, with p < 0.001 for all analyses. CONCLUSION: Endoscopic IGB treatment for excess weight is an excellent therapeutic option for patients with different degrees of overweight.

The protective arm of the renin-angiotensin system may counteract the intense inflammatory process in fetuses with posterior urethral valves.

OBJECTIVE: Posterior urethral valve is the most common lower urinary tract obstruction in male children. A high percentage of patients with posterior urethral valve evolve to end-stage renal disease. Previous studies showed that cytokines, chemokines, and components of the renin-angiotensin system contribute to the renal damage in obstructive uropathies. The authors recently found that urine samples from fetuses with posterior urethral valve have increased levels of inflammatory molecules. The aim of this study was to measure renin-angiotensin system molecules and to investigate their correlation with previously detected inflammatory markers in the same urine samples of fetuses with posterior urethral valve. METHODS: Urine samples from 24 fetuses with posterior urethral valve were collected and compared to those from 22 healthy male newborns at the same gestational age (controls). Renin-angiotensin system components levels were measured by enzyme-linked immunosorbent assay. RESULTS: Fetuses with posterior urethral valve presented increased urinary levels of angiotensin (Ang) I, Ang-(1-7) and angiotensin-converting enzyme 2 in comparison with controls. ACE levels were significantly reduced and Ang II levels were similar in fetuses with posterior urethral valve in comparison with controls. CONCLUSIONS: Increased urinary levels of angiotensin-converting enzyme 2 and of Ang-(1-7) in fetuses with posterior urethral valve could represent a regulatory response to the intense inflammatory process triggered by posterior urethral valve.

Aporte de la centellografía con trazadores tecneciados fosfatados al diagnóstico de amiloidosis cardíaca / Contribution of scintigraphy with technetium phosphated tracers to the diagnosis of cardiac amyloidosis / Contribuição da cintilografia com traçadores fosfatados com tecnécio para o diagnóstico de amiloidose cardíaca

Las amiloidosis son enfermedades causadas por el depósito patológico extracelular de un material proteico fibrilar e insoluble denominado amiloide, que puede estar vinculado a cadenas livianas (AL) o transtirretina (TTR). La amiloidosis cardíaca provoca una cardiomiopatía restrictiva de carácter progresivo caracterizada por falla cardíaca con función sistólica relativamente preservada, que se asocia a elevada mortalidad. Aunque el diagnóstico definitivo tradicionalmente se basa en la biopsia endomiocárdica, los avances en imagenología han mejorado su abordaje y la reciente introducción de terapias especificas permiten augurar cambios significativos en el pronóstico. El tratamiento difiere según el tipo de amiloide involucrado y su resultado depende de la instauración precoz de este, por lo cual resulta esencial un diagnóstico preciso y temprano. El centellograma cardíaco con fosfatos marcados (99mTc-PYP u otros), ampliamente disponible y de relativo bajo costo, se considera en la actualidad como una "biopsia molecular no invasiva" para el diagnóstico de la amiloidosis tipo ATTR, que debe ser usado en conjunto con la investigación de proteínas monoclonales en pacientes con sospecha clínica de la enfermedad.

Amyloidoses are diseases caused by the extracellular deposition of a fibrillar and insoluble protein material called amyloid, which can be linked either to light chains (AL) or transthyretin (TTR). Cardiac amyloidosis causes a progressive restrictive cardiomyopathy characterized by heart failure with relatively preserved systolic function, which is associated with high mortality. Although a definitive diagnosis is traditionally based on endomyocardial biopsy, advances in cardiac imaging have improved its approach, and the recent introduction of specific therapies predicts significant changes in prognosis. Since treatment differs according to the type of amyloid involved and the results depend on a prompt implementation, an accurate and early diagnosis is essential. Cardiac scintigraphy with labeled phosphates (99mTc-PYP or others), widely available and relatively inexpensive, is currently considered a "noninvasive molecular biopsy" for the diagnosis of ATTR type amyloidosis, which should be used in conjunction with investigation of monoclonal proteins in patients with clinical suspicion of the disease.

As amiloidoses são doenças causadas pela deposição patológica extracelular de um material proteico fibrilar e insolúvel, denominado amiloide, que pode estar ligado a cadeias leves (AL) ou transtirretina (TTR). A amiloidose cardíaca causa cardiomiopatia restritiva progressiva caracterizada por insuficiência cardíaca com função sistólica relativamente preservada, que está associada a alta mortalidade. Embora o diagnóstico definitivo seja tradicionalmente baseado na biópsia endomiocárdica, os avanços nos exames de imagem aprimoraram sua abordagem e a recente introdução de terapias específicas pode predizer mudanças significativas no prognóstico. O tratamento varia de acordo com o tipo de amiloide envolvida e seu resultado depende do início precoce, por isso um diagnóstico preciso e precoce é essencial. A cintilografia cardíaca com fosfatos marcados (99mTc-PYP ou outros), amplamente disponível e relativamente econômico, é atualmente considerada uma "biópsia molecular não invasiva" para o diagnóstico de amiloidose do tipo ATTR, que deve ser usada em conjunto com a investigação de proteínas monoclonais em pacientes com suspeita clínica da doença.

The protective arm of the renin -angiotensin system may counteract the intense inflammatory process in fetuses with posterior urethral valves / O braço protetor do sistema renina-angiotensina pode contrapor-se ao intenso processo inflamatório em fetos com válvula de uretra posterior

Abstract Objective: Posterior urethral valve is the most common lower urinary tract obstruction in male children. A high percentage of patients with posterior urethral valve evolve to end‐stage renal disease. Previous studies showed that cytokines, chemokines, and components of the renin-angiotensin system contribute to the renal damage in obstructive uropathies. The authors recently found that urine samples from fetuses with posterior urethral valve have increased levels of inflammatory molecules. The aim of this study was to measure renin-angiotensin system molecules and to investigate their correlation with previously detected inflammatory markers in the same urine samples of fetuses with posterior urethral valve. Methods: Urine samples from 24 fetuses with posterior urethral valve were collected and compared to those from 22 healthy male newborns at the same gestational age (controls). Renin-angiotensin system components levels were measured by enzyme‐linked immunosorbent assay. Results: Fetuses with posterior urethral valve presented increased urinary levels of angiotensin (Ang) I, Ang‐(1‐7) and angiotensin‐converting enzyme 2 in comparison with controls. ACE levels were significantly reduced and Ang II levels were similar in fetuses with posterior urethral valve in comparison with controls. Conclusions: Increased urinary levels of angiotensin‐converting enzyme 2 and of Ang‐(1‐7) in fetuses with posterior urethral valve could represent a regulatory response to the intense inflammatory process triggered by posterior urethral valve.

Resumo Objetivo: A válvula de uretra posterior é a obstrução do trato urinário inferior mais comum em crianças do sexo masculino. Uma alta porcentagem de pacientes com válvula de uretra posterior evolui para doença renal em estágio final. Estudos anteriores mostraram que citocinas, quimiocinas e componentes do sistema renina-angiotensina contribuem para o dano renal em uropatias obstrutivas. Recentemente, descobrimos que amostras de urina de fetos com válvula de uretra posterior tinham níveis aumentados de moléculas inflamatórias. O objetivo deste estudo foi medir as moléculas de renina-angiotensina e investigar sua correlação com marcadores inflamatórios previamente detectados nas mesmas amostras de urina de fetos com válvula de uretra posterior. Métodos: Amostras de urina de 24 fetos com válvula de uretra posterior foram coletadas e comparadas com amostras de urina de 22 recém-nascidos saudáveis de mesma idade gestacional (controles). Os níveis dos componentes de SRA foram medidos por ensaio de imunoabsorção enzimática. Resultados: Os fetos com válvula de uretra posterior apresentaram níveis urinários aumentados de angiotensina (Ang) I, Ang-(1-7) e enzima conversora de angiotensina 2 em comparação com os controles. Os níveis de enzima conversora de angiotensina eram significativamente menores e os níveis de Ang II eram semelhantes nos fetos com válvula de uretra posterior em comparação com os controles. Conclusões: O aumento dos níveis urinários de enzima conversora de angiotensina 2 e de Ang-(1-7) em fetos com válvula de uretra posterior poderia representar uma resposta regulatória ao intenso processo inflamatório desencadeado pela válvula de uretra posterior.

Hemorrhagic adrenal cyst.

The authors present a case of a hemorrhagic adrenal cyst, one of the tumors known in literature as incidentalomas, emphasizing the clinical characteristics, since adrenal cysts or pseudocysts are generally rare and observed by chance during imaging procedures. Traditionally they are classified as pseudocysts, endothelial, epithelial or parasitic cysts. Laparoscopic adrenalectomy has been considered the treatment of choice for benign, functioning or non-functioning adrenal lesions. Small cystic adrenal tumors can be managed conservatively by laparoscopic decortication or marsupialization, but larger cysts should be treated by total or partial adrenalectomy.

Trends in nuclear medicine in developing countries.

This article describes trends in nuclear medicine in the developing world as noted by nuclear medicine professionals at the International Atomic Energy Agency (IAEA). The trends identified are based on data gathered from several sources, including information gathered through a database maintained by the IAEA; evaluation of country program frameworks of various IAEA Member States; personal interactions with representatives in the nuclear medicine field from different regions of the world; official proceedings and meeting reports of the IAEA; participation in numerous national, regional, and international conferences; discussions with the leadership of major professional societies; and relevant literature. The information presented in this article relied on both objective and subjective observations. The aims of this article were to reflect on recent developments in the specialty of nuclear medicine and to envision the directions in which it is progressing. These issues are examined in terms of dimensions of practice, growth, and educational and training needs in the field of nuclear medicine. This article will enable readers to gain perspective on the status of nuclear medicine practice, with a specific focus on the developing world, and to examine needs and trends arising from the observations.

Panniculitis in the newborn: a case report.

The authors present a case of panniculitis in a newborn, a rare disease in the neonatal period discussing its causes and differential diagnosis, emphasizing a possible diagnosis of erythema nodosum.

Severe osteogenesis imperfecta: case report.

The authors present a case of Osteogenesis Imperfecta, emphasizing the clinical and epidemiological characteristics, forms of classification and treatment of the disease. This is an important case not only to the knowledge of pediatricians and orthopedists, but also for other professionals involved with the problem. This article has been jointly described by the Departments of Pediatrics and Neonatology of the Girassol Clinic in Luanda Capital of the Republic of Angola, Africa.

Local ecological knowledge is not a useful source of information concerning impacts caused by non-native Nile tilapia on fishery stocks / Conhecimento ecológico local não é uma informação útil acerca dos impactos causados pela exótica tilápia do Nilo sobre os estoques pesqueiros

Exotic freshwater fish can have deleterious effects on local biodiversity, although these impacts often only become apparent many years after the introduction. Local Ecological Knowledge (LEK) may be a useful source of information in situations where formal technical studies are insufficient, but few works have examined the reliability of information generated through this approach. We examined the reliability of LEK by investigating the impacts of Nile tilapia on fishery stocks in an artificial reservoir in northeastern Brazil. We gathered LEK from 29 experienced fishermen and then confronted this information with official fishery statistics from the same site. Twenty-two fishermen stated that total catch in the Gargalheiras Reservoir had declined over the years, 68% (N=15) of them began fishing before 1976 (the year Nile tilapia was introduced into reservoir). Of those 15 fishermen, 87% (N=13) stated that tilapia has not negatively affected other species, which ran counter to analyses of fishery statistics. Our study suggests that the LEK of fishermen is not a useful source of information concerning the impacts caused by exotic tilapia. However, the LEK added an overfishing hypothesis of the decline in fishery stocks in the Gargalheiras reservoir.

Espécies exóticas de peixes têm causado efeitos deletérios sobre a biodiversidade local de lagos, porém esses efeitos podem tornar-se aparentes apenas anos após a introdução. Em situações onde informações técnicas são insuficientes, o Conhecimento Ecológico Local (CEL) pode fornecer informações úteis, mas existem poucos estudos que avaliam a confiabilidade da informação gerada por essa abordagem. No presente estudo, nós avaliamos a confiabilidade do CEL acerca dos impactos da introdução da tilápia do Nilo sobre os estoques pesqueiros em um reservatório do nordeste do Brasil. Nós coletamos CEL de 29 pescadores experientes, utilizando questionários e, posteriormente, comparamos as informações com os resultados das estatísticas de pesca do mesmo reservatório. Vinte dois pescadores afirmaram que as capturas totais no reservatório Gargalheiras declinaram ao longo dos anos, 68% (N=15) deles começaram a pescar antes da introdução da tilápia no reservatório. Destes 15 pescadores, 87% (N=13) afirmaram que a tilápia não afetou negativamente outras espécies, contrariamente aos resultados das estatísticas de pesca. Nosso estudo indica que o CEL não é uma fonte útil de informação acerca dos impactos causados pela tilápia. No entanto, o CEL forneceu a hipótese de que a sobrepesca pode ter contribuído também para as reduções nos estoques pesqueiros de Gargalheiras.

Síndrome de transfusão feto-fetal, diagnóstico e tratamento: relato de caso / Twin-twin transfusion syndrome, diagnosis and treatment: case report

Objetivo: relatar um caso de síndrome de transfusão feto-fetal (STFF), demonstrando a importância do correto eprecoce diagnóstico ultrassonográfico e quando necessário a indicação da fotocoagulação a laser fetoscópica(FCLF) como melhor conduta terapêutica. Relato do caso: mulher 18 anos, secundigesta, gestação gemelarmonocoriônica diamniótica com diagnóstico ultrassonográfico tardio de STFF, devido não realização de prénatal.Realizados dois procedimentos de amniodrenagem como medida paliativa, evoluindo para partoprematuro no oitavo dia de internação. Um dos gêmeos evoluiu a óbito na UTI neonatal. Considerações finais:percebe-se a necessidade de uma melhor assistência pré-natal, treinamento dos profissionais médicos para arealização do diagnóstico ultrassonográfico correto e de investimentos em centros de Medicina fetal no Parápara tratamento adequado

Objective: to report a case of twin-twin transfusion syndrome (TTTS), demonstrating the importance of correctand early ultrasound diagnosis and when necessary the indication of laser photocoagulation fetoscópica (FCLF)as the best therapeutic approach. Case report: 18 years woman, in her second, diamniótica monochorionic twinpregnancy with late diagnosis of TTTS, because failure to carry out prenatal care. Evolved into premature laborafter cesarean with indication of two procedures amniodrenagem. After a cesarean section withoutcomplications was death of the twins in the NICU. Final considerations: we perceive the need to support theadequacy of prenatal care, training of medical professionals to perform the correct ultrasound diagnosis andinvestments in fetal medicine centers in Pará.

Câncer de mama e gestação: relato de caso / Breast cancer and pregnancy-case report

Objetivo: apresentar caso clínico de paciente internada em um hospital em Belém do Pará, com gestaçãocomplicada por câncer de mama. Relato do Caso: paciente de 43 anos, G4P3NA0, internada com 32semanas de gestação, para investigar anormalidade do líquido amniótico e suspeita de restrição docrescimento fetal. Portadora de neoplasia mamária localmente avançada teve gestação confirmada na 13ªsemana, após conclusão do segundo ciclo de quimioterapia neoadjuvante com AC-T (Adriblastina,Ciclofosfamida e Plactaxel). A gestação foi interrompida quando a paciente evoluiu com trabalho de partoprematuro.O diagnóstico neonatal apontou baixo índice de Apgar no primeiro minuto, prematuridade,baixo peso e suspeita de Síndrome de Down. Considerações finais: o caso estudado ratifica aimportância do planejamento familiar de pacientes em idade reprodutiva submetidas à quimioterapia, bemcomo o impacto desta terapêutica sobre o bem estar materno-fetal

Objective: to present the case of a patient admitted to a hospital in Belem, in which pregnancy wascomplicated by breast cancer. Case Report: patient 43, G4P3NA0, was admitted with 32 weeks ofgestation to investigate abnormalities of amniotic fluid and suspected fetal growth restriction. Patient withlocally advanced breast cancer was confirmed in 13 gestation weeks after completion of second cycle ofneoadjuvant chemotherapy with AC-T (Adriblastina, Cyclophosphamide and Plactaxel). The pregnancywas interrupted when patient developed preterm labor. The neonatal diagnosis showed low Apgar score inthe first minute, prematurity, low birth weight and suspected Down syndrome. Final considerations: thecase study confirms the importance of family planning patients of reproductive age receivingchemotherapy, as well as the impact of therapy on the maternal-fetal well-being.

Otite Média e Anquilose na Região Temporomandibular Causada por Fratura de Arma de Fogo. Relato de Caso / Otitis Media and Ankylosis in Temporomandibular Region Caused by Gunshot Fracture. Case Report

As fraturas mandibulares ocupam o segundo lugar dentre todas as fraturas do esqueleto facial. Atualmente, com o aumento da violência nos grandes centros urbanos, houve, também, um aumento de fraturas decorrentes de armas de fogo em civis, tornando-se necessário o seu estudo para elaboração de protocolos de diagnóstico e tratamento desses pacientes. O presente trabalho visa apresentar um caso clínico de fratura condilar por arma de fogo, sendo esse trauma também responsável por anquilose na região da articulação temporomandibular do mesmo lado, bem como otite média.

Mandibular fractures represent the most common facial fractures. Now, with the upsurge of violence in big citys, there was also an increase of fractures caused by gunshots on civilians, and its study for drawing up protocols of diagnosis and treatment of these patients. This work aims to present a clinical case of condilar fracture by gunshot, being this trauma also responsible for an ankylosis in the region of the temporomadibular joint, as well as an otitis.

Paniculite no recém-nascido: relato de um caso / Panniculitis in the newborn: report of a case

The authors present a case of panniculitis in a newborn, a rare disease in the neonatal period discussing its causes and differential diagnosis, emphasizing a possible diagnosis of erythema nodosum.

Os autores apresentam um caso clínico de paniculite no recém-nascido, uma afecção rara no período neonatal, discutindo suas prováveis causas e diagnóstico diferencial, enfatizando possível diagnóstico de eritema nodoso.