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ABSTRACT Endometriosis is a common disease; however, unusual findings may cause diagnostic difficulties. We present herein three cases illustrating different morphological appearances of endometriosis: 1) endometriosis with atypical hyperplasia associated with bilateral ovarian carcinoma (mixed clear cell/endometrioid in the left ovary and endometrioid in the right ovary); 2) deep infiltrating endometriosis with intravascular spread, polypoid configuration in peritoneal surfaces, and involvement of a lymph node; and 3) decidualized endometriosis with prominent myxoid/mucinous change and multivacuolated (pseudoxanthoma) cells. Awareness of uncommon morphological manifestations of endometriosis is important to avoid improper consideration of malignancy.
ABSTRACT
Justificativa: A dor é um problema de saúde pública, comprometendo sobremaneira a qualidade de vida. Quase 80% dos pacientes com dor crônica relataram que a dor interfere em suas atividades da vida diária, e dois terços afirmaram que a dor provoca impacto negativo nas relações pessoais. A incapacidade física e funcional, seja temporária ou permanente, compromete a atividade profissional e causa absenteísmo ao trabalho, elevando os custos dos sistemas de saúde. Objetivos: O objetivo desta revisão é analisar, com base na literatura, o efeito analgésico da lidocaína administrada por via intravenosa no tratamento da dor crônica e avaliar a redução da intensidade da dor em pacientes com dor crônica, focando a etiologia musculoesquelética e neuropática. Metodologia: O método adotado foi o de revisão da literatura, consistindo na busca de artigos científicos sobre a eficácia da infusão intravenosa de lidocaína no tratamento de pacientes com dor crônica. Conteúdo: Dos 19 estudos revisados, 12 apresentaram resultados que confirmam a ação analgésica da lidocaína por via intravenosa em pacientes com dor crônica. A maioria dos autores utilizou doses de 5 mg/kg infundidas por 30 minutos ou mais, produzindo analgesia significativa com duração variável (de minutos a semanas). Conclusões: Com base na revisão da literatura, não é possível uniformemente especificar a dose mais eficaz e segura de lidocaína administrada por via intravenosa no tratamento da dor neuropática ou musculoesquelética. Quanto à eficácia, a infusão intravenosa da lidocaína como alternativa para o tratamento da dor crônica de etiologias diversas parece bastante promissora, embora estudos adicionais necessitem ser realizados. .
Background: Pain is a public health problem, greatly impairing quality of life. Almost 80% of patients with chronic pain reported that their pain interferes with activities of daily living, and two thirds reported that the pain causes negative impact on their personal relationships. The physical and functional disability, whether temporary or permanent, compromises the professional activity and causes work absenteeism, increasing costs of health systems. Objectives: The aim of this review is to analyze, based on the literature, the analgesic effect of lidocaine administered intravenously for the treatment of chronic pain and to evaluate the reduction of pain intensity in patients with chronic pain, focusing on musculoskeletal and neuropathic etiology. Methodology: The method used was a review the literature, consisting in searching the scientific literature on the efficacy of intravenous lidocaine infusion in the treatment of patients with chronic pain. Content: Of the 19 studies reviewed, 12 had results that confirm the analgesic effect of intravenous lidocaine in patients with chronic pain. Most authors used doses of 5 mg/kg infused for 30 minutes or more, producing significant analgesia with variable duration (minutes to weeks). Conclusions: Based on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted. .