Parathyroid carcinoma and oxyphil parathyroid adenoma: an uncommon case of misinterpretation in clinical practice.

A 46 year-old male presented with persistently high level of serum parathyroid hormone (PTH), despite successful resection of an oxyphilic cell parathyroid adenoma of the left lower gland. Renal function and serum calcium were normal, leading to vitamin D deficiency being considered. Tc99m-sestamibi parathyroid scintigraphy showed no capitation, but a cervical ultrasound demonstrated an increase in the lower parathyroids. Surgery confirmed that the right gland was normal but the left corresponded to parathyroid carcinoma. The patient developed severe hypocalcemia, with PTH values being consistent with hypoparathyroidism for a few months. However, a progressive increase in calcium and PTH serum levels indicated recurrence of disease. Tc99m-sestamibi scintigraphy demonstrated hyperfixation in topography of the left inferior parathyroid and the patient was subjected to a third and more extensive surgery, with removal of lymph nodes and adjacent thyroid tissue. Serum calcium and PTH remained elevated, requiring loop diuretics and intravenous bisphosphonates to control hypercalcemia. Cervical radiotherapy was implemented as adjuvant therapy. After two months the patient complained of dyspnea, and a CT scan of the chest demonstrated areas of parenchymal condensation, suggestive of actinic pneumonitis. At the 2-year follow-up no major issues were evident.

Covid-19 rapid test by combining a Random Forest-based web system and blood tests.

The disease caused by the new type of coronavirus, Covid-19, has posed major public health challenges for many countries. With its rapid spread, since the beginning of the outbreak in December 2019, the disease transmitted by SARS-CoV-2 has already caused over 2 million deaths to date. In this work, we propose a web solution, called Heg.IA, to optimize the diagnosis of Covid-19 through the use of artificial intelligence. Our system aims to support decision-making regarding to diagnosis of Covid-19 and to the indication of hospitalization on regular ward, semi-ICU or ICU based on decision a Random Forest architecture with 90 trees. The main idea is that healthcare professionals can insert 41 hematological parameters from common blood tests and arterial gasometry into the system. Then, Heg.IA will provide a diagnostic report. The system reached good results for both Covid-19 diagnosis and to recommend hospitalization. For the first scenario we found average results of accuracy of 92.891%±0.851, kappa index of 0.858 ± 0.017, sensitivity of 0.936 ± 0.011, precision of 0.923 ± 0.011, specificity of 0.921 ± 0.012 and area under ROC of 0.984 ± 0.003. As for the indication of hospitalization, we achieved excellent performance of accuracies above 99% and more than 0.99 for the other metrics in all situations. By using a computationally simple method, based on the classical decision trees, we were able to achieve high diagnosis performance. Heg.IA system may be a way to overcome the testing unavailability in the context of Covid-19.Communicated by Ramaswamy H. Sarma.

Retalho de avanço para correção de hemangiossarcoma em região peniana de cão: relato de caso / Advancement flap in dog penile region due to cutaneous hemangiosarcoma: case report / Uso de venta al por menor avanzada en la región penial del perro debido al hemangiosarcoma cutáneo: informe de caso

O uso de técnicas de cirurgia reconstrutiva é de grande importância quando há perda de uma ampla quantidade de tecido cutâneo. O objetivo deste trabalho é relatar a utilização da técnica de retalho de avanço pediculado em decorrência de extensa ausência de tecido cutâneo resultante da exérese de neoplasia na região peniana de um cão. O presente estudo relata o caso de um cão da raça American Pitbull Terrier, macho castrado, com sete anos de idade, com histórico de neoplasia e aumento de nódulo na região peniana. Após avaliação clínica do animal, achou-se por bem o tratamento por meio da remoção cirúrgica do neoplasma. Durante o procedimento cirúrgico constatou-se que seria necessário o emprego de um retalho de avanço pediculado para fechamento da ferida ocasionada pela remoção da neoplasia. Para diminuir a tensão e os riscos de complicações no retalho, foi realizada uma "walking suture" no subcutâneo, técnicas essas que garantiram uma cicatrização com aspecto estético e funcional satisfatório com o mínimo de tensão.(AU)

The use of reconstructive surgery techniques is of great importance when there is loss of a large amount of cutaneous tissue. The objective of this study is to report the use of pedicle flap technique as a result of extensive absence of cutaneous tissue resulting from the excision of neoplasia in the penile dog region. The present study reports the case of a seven year old male Pitbull Terrier, with a history of neoplasia and nodule enlargement in the penile region. After the clinical evaluation of the animal, the treatment by the surgical removal of the neoplasm was considered good. During the surgical procedure, it was found that a pedicle flap should be used to close the wound caused by removal of the neoplasia. To reduce tension and risk of complications in the flap, a walking suture was performed on the subcutaneous tissue, which ensure healing with aesthetic and functional appearance with minimal tension.(AU)

El uso de técnicas de cirugía reconstructiva es de gran importancia cuando se pierde una gran cantidad de tejido de la piel. El objetivo de este estudio es informar el uso de la técnica de colgajo de avance pediculado debido a la extensa ausencia de tejido de la piel como resultado de la escisión de la neoplasia en la región del pene del perro. El presente estudio informa el caso de un Pitbull Terrier americano de siete años, un hombre castrado, con antecedentes de neoplasia y un nódulo agrandado en la región del pene. Después de la evaluación clínica del animal, se consideró el tratamiento mediante la extirpación quirúrgica de la neoplasia. Durante el procedimiento quirúrgico, se descubrió que el uso de un colgajo de avance pediculado sería necesario para cerrar la herida causada por la extirpación de la neoplasia. Para reducir la tensión y el riesgo de complicaciones en el colgajo, se realizó una sutura ambulante en el tejido subcutáneo, técnicas que aseguraron la curación con un aspecto estético y funcional satisfactorio con una tensión mínima.(AU)

Reconstrução vaginal pelo retalho neurovascular pudendo crural na Síndrome de Rokitansky / Vaginal reconstruction by neurovascular pudendal thigh flap in Rokitansky’s Syndrome

Introdução: Agenesia vaginal relacionada à síndrome de Mayer-Rokitansky-Kuster-Hauser (MRKH) ocorre na proporção de 1 para cada 4000 ou 5000 nascimentos femininos, causando grande limitação à vida afetiva da paciente. O manejo da agenesia vaginal inclui acompanhamento psicológico e reconstrução vaginal. Objetivo: Mostrar a experiência do serviço com a técnica do retalho neurovascular pudendo crural para reconstrução vaginal no tratamento de 8 pacientes com síndrome de Rokitansky. Método: Apresentam-se oito casos de síndrome de Rokitansky em que a reconstrução vaginal foi realizada pelo retalho neurovascular pudendo crural, chamado retalho de Cingapura. O período de acompanhamento pós-operatório variou de 6 meses e 3 anos. Resultados: Uma neovagina funcional de, no mínimo, 10 cm. de profundidade e 5 cm. de diâmetro foi criada em todos os casos. Apesar da queixa de dor local de moderada intensidade no pós-operatório imediato, as pacientes apresentaram-se satisfeitas com os resultados. As relações sexuais foram liberadas no 40º dia de pós-operatório, sem relatos de sangramento ou dor. Três pacientes apresentaram crescimento de pêlo no intróito vaginal. Conclusão: A técnica do retalho de Cingapura permitiu a reconstrução vaginal sem a necessidade de dilatação pós-operatória, mantendoa inervação do períneo e com cicatrizes pouco perceptíveis.

Background: Congenital vaginal agenesis, with a prevalence of 1 in 4000 or 5000 females, occurs mainly as a feature of the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The management of this patient includes psychological support and the creation of a neovagina. Objective: To present and evaluate the pudendal thigh flap for the creation of a neovaginain eight young women with MRKH syndrome. Methods: Eight young women with MRKH syndrome had a neovagina created by using the bilateral pudendal thigh fasciocutaneous flap procedure, Singapore flap. The patients’ follow-up ranged between 6 months and 3 years. Results: A functional vagina of at least 10 cm. in depth and 5 cm. in width was createdin al cases. Although the patients reported moderated local pain after the procedure, they were satisfied with the results. In addition, normal sexual life was possible after 40 days and none of them reported bleeding or pain during sexual relation. Three patients presented hair in the vaginal lining. Conclusion: Bilateral fasciocutaneous pudendal thigh flap permits vaginal reconstruction with some advantages such as postoperative dilatation is not necessary, sensation is maintained and the resulting scars are inconspicuous.