Fibroadenoma in axillary accessory breast: a case report

The mass are among the possible alterations observed in the axilla. When found, the most frequent differential diagnosis are lymphadenopathy, metastatic lymphadenomegaly, lymphoma, lipoma or tumors in the apocrine glands. Besides that, the presence of accessory breast tissue must also be considered and, as the topical breast tissue, can be the target of breast diseases, either benign or malignant. Female patient, 23 years old, with the presence of hardened palpable node in the right axilla. At the ultrasound, it presented characteristics that classified it as Bi-Rads® 4. An aspiration biopsy of the node was performed with fine-needle, which resulted in unsatisfying material. After the explanation of the therapeutic choices, the patient opted for the excision of the axillary node. The anatomical pathological result showed a nodular formation compatible with fibroadenoma. The occurrence of a node in the axillary region is common. However, in the vast majority of times, it is merely an inflammatory response, manifested as a lymphadenomegaly. In case of chronic mass with suspicious characteristics, it is convenient to suspect the presence of lymphoid neoplasms, locoregional metastasis of breast cancer or melanoma and alterations in accessory breast tissue. In young patients, it is important to evaluate the existence of accessory breast tissue with the presence of suspicious axillary node, because, although controversial, some authors believe that such alterations occur more frequently in these patients. Additionally, in cases of inconclusive imaging, an excision of the lesion must be performed for a definite diagnosis.

A história obstétrica de gestantes com trombofilias hereditárias / Obstetric history of pregnant women with hereditary thrombophilias

Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x2 =4,2) e de pré-eclâmpsia (p=0,03; X2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica. (AU)

Introduction: Venous thromboembolic disease and obstetric complications resulting from placental thromboembolism are the main causes of maternal and fetal morbidity and mortality. Pregnancy is considered an independent factor for the development of thrombosis, as its risk is 5 to 6 times greater in pregnant women when compared to non-pregnant women, being even higher after childbirth. Methods: This historical cohort included patients seen at the Obstetrics Service of Federal University of Juiz de Fora (exposed patients, n = 70) and at the School of Medicine of Barbacena (unexposed patients, n = 74). The patients were divided into two groups: Group 1 consisted of patients with some thrombophilia identified through measurement of protein S, protein C, homocysteine, antithrombin III, MTHFR mutation, prothrombin and factor V Leiden mutations; and Group 2 consisted of patients from the low obstetric risk service. Results: There was an association between thrombophilia and previous abortion, as well as thrombophilia and previous fetal death (p < 0.05). MTHFR mutation was associated with history of HELLP syndrome (p = 0.03; x2 = 4.2) and preeclampsia (p = 0.03; x2 = 4.5) when in homozygous mutation. Homozygous MTHFR was also associated with mean homocysteine levels, so that homozygotes were those with highest homocysteine levels (p = 0.01; x2 = 5.8; x = 27.2 ± 41.2 vs. 12.62 ± 19.0). Conclusions: Hereditary thrombophilias may be associated with poor obstetric outcome and should be valued at clinical obstetrics. (AU)

Discussão Ética sobre o Prontuário Eletrônico do Paciente / The Ethics of Electronic Medical Records

RESUMO O prontuário do paciente constitui uma ferramenta fundamental para a prestação do cuidado em saúde, podendo ser definido como um registro padronizado e organizado de toda a informação referente à saúde de um indivíduo, desde o nascimento até a morte. Na década de 1970, impulsionados pelo crescente desenvolvimento da tecnologia, surgem os primeiros sistemas de Prontuários Eletrônicos do Paciente (PEP), sob uma proposta de informatização dos registros em saúde. Por meio de uma criteriosa pesquisa bibliográfica, questões concernentes ao prontuário eletrônico do paciente foram discutidas, especialmente do ponto de vista ético. Os avanços tecnológicos aplicados à área de saúde devem ser implantados de maneira crítica, em que pesem as consequências imprevistas que possam ter quanto à relação médico-paciente, uma vez que o cuidado e o respeito devem ser prioridade, e não os interesses particulares. Por isso, uma análise apenas técnica não abarca elementos que podem ser compreendidos à luz dos conceitos éticos, os quais norteiam escolhas baseadas no interesse comum.

ABSTRACT Electronic Medical Records serve as a fundamental tool in the healthcare service and may be defined as standardized and organized records featuring all the information on a patient’s medical history since birth. Due to technological developments, the first Electronic Medical Records were created in the 1970s in order to computerize records in the healthcare field. Bibliographical research was carried out in order to discuss aspects of electronic medical records, especially concerning their ethical dimensions. Technological improvements should be considered in a more critical way, since there may be unforeseen consequences related to their use, especially related to the doctor-patient relationship. Despite technology’s importance in improving healthcare services, care and respect should always be of priority and personal interests should be avoided. An analysis that highlights only the technical aspects of Electronic Medical Records is therefore insufficient to answer all the questions that might arise, with ethical concepts perhaps playing a role in answering such questions.