ABSTRACT
Abstract Pituitary apoplexy refers to a rare clinical syndrome consisting of signs and symptoms that occur due to rapid expansion of the contents of the sella turcica. It can occur spontaneously or associated with pituitary tumors. It can have a broad clinical spectrum, but usually presents with severe headache, visual impairment and hypopituitarism. Sudden onset of symptoms associated to imagiologic confirmation makes the diagnosis. Surgical treatment is advised when there is important compression of the optic tract. We present a case report and a review of the literature on pituitary apoplexy in pregnancy. The cases were reviewed to obtain information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. Our review found 36 cases of pituitary apoplexy in pregnancy. Most of the cases occurred in the second trimester of pregnancy and headache was the most frequent symptom at presentation. Surgical therapy was required in more than half of the patients. In what respect maternal and fetal outcomes, there were 3 cases of preterm delivery and one case of maternal death. Our clinical case and literature review reinforces the importance of an early diagnosis to avoid potential adverse consequences.
Subject(s)
Humans , Female , Pregnancy , Adult , Pituitary ApoplexyABSTRACT
SUMMARY Thyroid angiosarcoma is an extremely rare malignancy, which occurs more frequently in the alpine region, likely associated with iodine deficiency and endemic goiter. This is an aggressive neoplasm that usually harbors a poor prognosis. We report the case of a 49-year-old Portuguese female patient presenting with a large nodule in the anterior neck region, with rapid growth and associated dysphonia. The neck ultrasound showed a hypoechogenic and heterogeneous thyroid nodule, with a larger axis of 44 mm. The fine needle aspiration cytology was not conclusive, and a biopsy of the lesion was performed. The result was suggestive of a mesenchymal tumor constituted by spindle cells and vascular clefts, showing positivity for endothelial markers and negativity for thyroglobulin, calcitonin and TTF1. The chest CT scan performed before surgery showed multiple pulmonary nodules suggestive of secondary lesions. The patient was submitted to total thyroidectomy and lymph node dissection in order to relieve compressive symptoms. A diagnosis of thyroid angiosarcoma was made after histologic examination of the surgical specimen. Despite undergoing multiple lines of palliative chemotherapy, the pulmonary lesions increased in size and number. The patient died due to respiratory failure 29 months after the diagnosis. Thyroid angiosarcoma is a rare malignancy, generally with poor prognosis. In our case, the patient presented with pulmonary metastases at diagnosis, which is a negative prognostic factor. Due to its rarity, data regarding management and treatment of this disease are scarce.
ABSTRACT
Abstract Introduction: Latin America is a large and diverse region, comprising more than 600 million inhabitants and one million physicians in over 20 countries. Resistance to antibacterial drugs is particularly important in the region. This paper describes the design, implementation and results of an international bi-lingual (Spanish and Portuguese) online continuing interprofessional interactive educational program on hospital-acquired infections and antimicrobial resistance for Latin America, supported by the American Society for Microbiology. Methods: Participation, satisfaction and knowledge gain (through pre and post tests) were used. Moreover, commitment to change statements were requested from participants at the end of the course and three months later. Results: There were 1169 participants from 19 Latin American countries who registered: 57% were physicians and 43% were other health care professionals. Of those, 1126 participated in the course, 46% received a certificate of completion and 54% a certificate of participation. There was a significant increase in knowledge between before and after the course. Of 535 participants who took both tests, the grade increased from 59 to 81%. Commitments to change were aligned with course objectives. Discussion: Implementation of this educational program showed the feasibility of a continent-wide interprofessional massive course on hospital acquired-infections in Latin America, in the two main languages spoken in the region. Next steps included a new edition of this course and a "New Challenges" course on hospital-acquired infections, which were successfully implemented in the second semester of 2015 by the same institutions.
Subject(s)
Humans , Cross Infection , Health Personnel/education , Internet , Interdisciplinary Communication , Education, Continuing/methods , Education, Professional/methods , Multilingualism , Education, Continuing/standards , Education, Professional/standards , Latin AmericaABSTRACT
La infección nosocomial se ha transformado en uno de los más serios problemas en la práctica hospitalaria contemporánea. En las unidades de cuidado intensivo, estas complicaciones adquieren una particular gravedad, en razón de su frecuencia, localización predominantemente respiratoria con elevada morbimortalidad asociada y caracter multirresistente de los agentes causales. En el presente trabajo, se analizan las características de la colonización/infección respiratoria de dos gérmenes causantes de infección nosocomial: Acinetobacter spp. y Stenotrophomonas maltophilia, en los que se analizan datos demográficos, estados comorbidos, cronología en la aparición de estos agentes en relación a la estadía en cuidados intensivos y la ventilación mecánica y finalmente, la evolución. Así mismo se hace una revisión de la bibliografía desde el punto de vista epidemiológico, en relación a estos dos agentes. A partir de lo anterior es posible concluir que se trata de germenes nosocomiales emergentes, particularmente en áreas críticas, que se localizan con frecuencia en la vía de aire artificial, en la que aparecen tardíamente, luego de la primera semana y a menudo formando parte de una flora polimicrobiana. El significado de la presencia de estos agentes en la vía de aire es controversial, ya que pueden ser simples colonizantes o ser causantes de neumonía, la que plantea aspectos polémicos en cuanto a la indicación y oportunidad del uso de antimicrobianos
Subject(s)
Humans , Male , Female , Acinetobacter Infections , Cross Infection , Gram-Negative Bacterial Infections , Intensive Care Units , Respiration, Artificial/adverse effects , Respiratory Tract Infections , Stenotrophomonas maltophiliaABSTRACT
La técnica descripta se halla avalada por más de 30 años de experiencia y un número de pacientes operados que con seguridad supera la cifra de 1000. Los fundamentos específicos están dados por la sutura del lecho cruento luego de la resección del paquete primario, para lo cual se debe cuidar de extirpar la piel y mucosa muy próxima al pliegue hemorroidario, a los fines de realizar la sutura sin tensión. No se ha registrado en nuestra casuística, infección, hemorragia, intolerancia ni estrechez. Con este procedimiento el dolor operatorio se modifica, disminuyendo notablemente y el postoperatorio se abrevia