Clinical effects of bi-level positive airway pressure and heated humidified high flow nasal cannula ventilation as initial treatment for premature infants with respiratory distress syndrome / 中国新生儿科杂志

Objective:To compare the efficacy and safety of bi-level positive airway pressure (BiPAP) ventilation and heated humidified high flow nasal cannula (HHHFNC) ventilation as initial respiratory support for premature infants with respiratory distress syndrome (RDS).Methods:From January 2019 to June 2021, premature infants [gestational age (GA) 28~35 weeks)] with grade Ⅰ to Ⅲ RDS admitted to Suining County People's Hospital were prospectively enrolled. The infants were randomly assigned into BiPAP group and HHHFNC group. The clinical characteristics, ventilation efficacy and complications were analyzed.Results:A total of 33 infants were in BiPAP group and 32 in HHHFNC group. No significant differences existed between the two groups in the following items: the frequency of apnea within 24 h of ventilation, FiO 2 and PaCO 2 at 24 h, the use of pulmonary surfactant (PS), the incidence of non-invasive ventilation failure within 72 h, non-invasive ventilation duration and the age achieving total enteral nutrition. HHHFNC group had lower score in premature infants pain profile (PIPP) than BiPAP group at 24 h of non-invasive ventilation [4 (3, 6) vs. 8 (6, 11), P<0.001]. No significant differences existed in nasal injury, pneumothorax, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and mortality rate between the two groups ( P>0.05). Conclusions:As the initial treatment for premature infants with grade Ⅰ to Ⅲ RDS, BiPAP and HHHFNC has similar rates of non-invasive ventilation failure within 72 h,non-invasive ventilation duration and adverse events. HHHFNC may ease the pain of the infants.

Mília sobre tatuagem: tratamento conservador bem-sucedido / Milia over tattoo: successful conservative treatment

Mília são cistos de queratina de 1-3mm de diâmetro, que ocorrem devido à obstrução de glândulas sudoríparas écrinas ou de folículos pilosos. Descrevemos um caso em paciente feminina, com múltiplas pápulas branco-amareladas, distribuídas sobre uma tatuagem realizada seis meses antes da consulta médica. O tratamento conservador é uma opção, uma vez que há a possibilidade de que a lesão seja transitória e desapareça espontaneamente. Optamos por tratamento conservador com ótimo resultado estético final.

Milia are keratin cysts of 1-3mm in diameter that occur due to the obstruction of eccrine sweat glands or hair follicles. We describe the case of a female patient with multiple white-yellow papules over a tattoo made six months prior to the consultation. Conservative treatment is an option, since there is the possibility of the lesion being transient and that it will spontaneously resolve. We opted for a conservative treatment with excellent final cosmetic outcome.

Genitourinary tuberculosis - a rare presentation of a still frequent infection in renal transplant recipients / Tuberculose genitourinária - uma apresentação rara de uma infeção ainda frequente nos doentes transplantados renais

Abstract Mycobacterium tuberculosis infection in renal transplant recipients is associated with significant morbidity and mortality. Genitourinary tuberculosis is a less frequent presentation and a high level of suspicion is needed to avoid treatment delay. Management is challenging due to the interaction of calcineurin inhibitors with antituberculous medications and the known side effects of these drugs, with higher prevalence in this population. The authors present a case of a renal transplant recipient with urinary and constitutional symptoms whom is diagnosed with tuberculosis after a prostatic biopsy in an already disseminated stage and develops hepatotoxicity to antituberculous therapy.

Resumo A infeção por Mycobacterion tuberculosis nos doentes transplantados renais está associada a morbilidade e mortalidade significativas. A tuberculose genitourinária é uma apresentação menos frequente desta infeção e é necessário um elevado índice de suspeição para evitar atraso no diagnóstico e tratamento. A abordagem terapeutica é desafiante dada a interação dos inibidores da calcineurina com os tuberculostáticos e os vários efeitos secundários destes fármacos, mais prevalentes nesta população. Os autores apresentam um caso de um doente transplantado renal com sintomas urínários e constitucionais que é diagnosticado com tuberculose após biópsia prostática e que desenvolve hepatotoxicidade à terapeutica.

Guía de práctica clínica para el tratamiento de la diabetes mellitus tipo 2: manejo inicial / Clinical Practice Guideline for Treatment of Type 2 Diabetes Mellitus: Initial Treatment

Introducción: En la actualidad es ampliamente aceptada la metformina como manejo farmacológico inicial para el tratamiento de la diabetes mellitus tipo 2 (DMT2). Resulta, sin embargo, controversial si en algunos tipos de pacientes puede iniciarse tratamiento únicamente con cambios intensivos de estilo de vida o si existen grupos en quienes debería iniciarse desde el inicio terapia farmacológica combinada. Objetivo: Definir el impacto de estrategias de cambio intensivo en la dieta y de ejercicio, así como de la terapia farmacológica con metformina asociada a un segundo antidiabético oral como estrategias de manejo inicial en pacientes con DMT2 recién diagnosticada. Métodos: Se elaboró la guía de práctica clínica, siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social colombiano. Se revisó la evidencia disponible de forma sistemática y se formularon las recomendaciones utilizando la metodología GRADE. Conclusiones: En pacientes con DMT2 recién diagnosticada no se recomienda el manejo únicamente con cambios intensivos del estilo de vida; estos deben acompañar el manejo farmacológico con metformina, dando prelación a los componentes de la dieta mediterránea y al ejercicio aeróbico. En los pacientes con DMT2 recién diagnosticada y niveles de HbA1C > 8 % se recomienda utilizar terapia combinada desde el inicio con metformina y otro antidiabético oral, siendo de primera elección los inhibidores de DPP-4.

Introduction: Today, metformin is widely accepted as standard initial pharmacologic treatment for diabetes mellitus type 2 (DMT2). However, it is controversial if in some groups of patients, the treatment can be initiated only with life style changes, or if there are groups who should begin with combined therapy since the beginning. Aim: To define the effect of intensive strategies for change of diet or exercise, and the effect of combined therapy with metformin and a second oral antidiabetic, as initial treatment in patients with newly DMT2. Methods: A clinical practice guide has been developed following the broad outline of the methodological guide from the Colombian Ministry of Health and Social Welfare. with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Conclusions: In patients with recently diagnosed DMT2, initial treatment with lifestyle changes only is not recommended. However, it is recommended that lifestyles changes must begin simultaneously with metformin, including the components of a Mediterranean diet and aerobic exercise. In patients with recently diagnosed DMT2 and HbA1c levels >8%, it is recommended to administer a combined therapy from the beginning with metformin and another oral antidiabetic medication. The DPP4 inhibitor is recommended.

Hemangiopericitoma de Bexiga: relato de uma patologia rara / Hemangiopericytoma of the bladder: report of a rare disease

A maioria dos tumores da bexiga é formada por células transicionais. Hemangiopericitoma é um tumor de tecidos moles e apresenta grande variabilidade histológica e ocorrência extremamente rara na bexiga. Neste trabalho é relatado um caso de hemangiopericitoma de bexiga em um paciente de 23 anos. Os achados clínicos e anatomopatológicos deste tumor são discutidos no presente relato, com revisão da literatura(AU)

Most bladder tumors are formed by transitional cells. Hemangiopericytoma is a soft tissue tumor which presents great histologic variability and extremely rare occurrence in the bladder. Here the authors report a case of hemangiopericytoma of the bladder in a 23-year-old patient. The clinical and pathological features of this tumor are discussed in this report with a literature review(AU)

Granuloma faciale: a good therapeutic response with the use of topical tacrolimus

AbstractGranuloma faciale is a rare dermatosis of chronic course, benign, usually asymptomatic, first described in 1945 by Wingley. It is characterized by the appearance of well-defined, single or multiple papules, plaques and nodules, predominantly located in sun-exposed areas, especially the face. In this work we report the case of a female patient, 58 years old, evolving for ten years with multiple erythematous-brownish and asymptomatic papules on the face, whose histological examination confirmed the diagnosis of granuloma faciale. The patient was treated with topical tacrolimus, evolving with regression of lesions.

Bullous and hemorrhagic lichen sclerosus - Case report

Lichen sclerosus is a chronic inflammatory disease, usually located in the genital area. The etiology of lichen sclerosus is multifactorial, with participation of genetic, autoimmune, infectious and hormonal factors. Bullous clinical form stems from hydropic degeneration of the basal membrane, constituting a less frequent variant of the disease. In this work, we report the case of a female patient, 55 years old, who in the last three years presented whitish plaques, with horny spikes, located on back and arms. Some of these lesions evolved with hemorrhagic blisters, which after histopathological examination confirmed the diagnosis of bullous and hemorrhagic lichen sclerosus. The patient was treated with high-potency topical corticosteroid for two months, resulting in remission of bullous and hemorrhagic lesions.

Atendimento inicial às queimaduras de mão: revisão da literatura / Initial assistance to hand burns: literature review

OBJETIVOS: Abordar, por meio de uma revisão da literatura, o manejo das queimaduras de mão, com ênfase nos cuidados iniciais. MÉTODOS: No período entre fevereiro e julho de 2015, foram revisados 30 artigos selecionados nas bases de dados MedLine/PubMed, LILACS, SciELO e Google Acadêmico, inclusos tanto os de língua inglesa quanto portuguesa, publicados nos últimos 10 anos e que correspondessem aos seguintes descritores: queimadura de mão; ferimento de mão; tratamento agudo; tratamento primário; e seus correspondentes em inglês. RESULTADOS: É apresentada a classificação das queimaduras conforme a profundidade, extensão e fatores agravantes. São abordadas as condutas iniciais que evitam complicações como mão em garra, síndrome compartimental e infecções. Os procedimentos iniciais incluem curativos oclusivos, escarotomia, fasciotomia, abertura do túnel do carpo, seguidos por curativos com agentes antimicrobianos tópicos, desbridamento e enxertos. São discutidos aspectos controversos sobre o momento mais indicado para a intervenção cirúrgica, caso esta seja necessária. CONCLUSÕES: A correta abordagem inicial da queimadura de mão poderá evitar sequelas irreversíveis. O manejo adequado na queimadura de mão inclui desde a avaliação clinica inicial da área queimada por um médico generalista à realização de condutas precoces com o objetivo de evitar a perda de função do membro e futuras reconstruções desnecessárias. A elevada incidência desse tipo de queimadura também acentua a relevância de uma conduta adequada.

AIMS: To address, through a literature review, the management of hand burns, with emphasis on the initial care. METHODS: Between February and July 2015, 30 articles selected in the databases Medline/PubMed, LILACS, SciELO and Google Scholar were reviewed. Both the English and Portuguese languages were included in the search. Selected articles were published in the last 10 years and matched the following descriptors: hand burn; hand injury; acute treatment; primary treatment; and their counterparts in Portuguese. RESULTS: Classification of burns is displayed, including depth, extent and aggravating factors. The initial management that avoid complications such as claw hand, compartment syndrome and infection is addressed. Early procedures include occlusive dressings, escharotomy, fasciotomy, and carpal tunnel opening, followed by dressings with topical antimicrobial agents, debridement and grafting. Controversial aspects are discussed on the most appropriate time for surgical intervention, if it is necessary. CONCLUSIONS: The correct early approach to hand burns can prevent irreversible consequences. The appropriate management on hand burns includes since the initial clinical evaluation of the burned area by a general practitioner, to the realization of early procedures in order to prevent limb function loss and unnecessary future reconstructions. The high incidence of this type of burn also stresses the importance of a proper conduct.

Características clínicas, radiográficas e diagnóstico do ameloblastoma: relato de caso / Clinical and radiographic features and diagnosis of ameloblastoma: a case report

O ameloblastoma é um tumor benigno comumente encontrado nos ossos gnáticos, originário de remanescentes da lâmina dentária. Quanto ao comportamento clínico, trata-se de um tumor de crescimento lento, normalmente assintomático, podendo provocar deslocamento, mobilidade e reabsorção dentária, assim como parestesia. Radiograficamente, pode apresentar-se como lesões radiolúcidas uni ou multiloculares, normalmente com limites bem definidos de forma semelhante a "favos de mel" ou "bolhas de sabão". Histologicamente, possui diversos padrões, principalmente a variante multicística. Existem diversos métodos de tratamento, desde a enucleação e curetagem a ressecções mais agressivas, com ou sem perda da continuidade óssea. O ameloblastoma, por ser um tumor agressivo, possui grande percentual de recidiva e o prognóstico depende de vários fatores, desde os aspectos clínicos, radiográficos e histopatológicos que definem o seu comportamento biológico. O objetivo deste trabalho é relatar as características clínicas e radiográficas no direcionamento do diagnóstico e na escolha do tratamento adequado para o ameloblastoma baseado na descrição de um relato de caso clínico... (AU)

Ameloblastoma is a benign neoplasm commonly found in maxillary bones, formed from remnants of dental lamina. As regards its clinical behavior, it is a tumor of slow growth, usually asymptomatic, causing displacement, mobility, tooth resorption, and paresthesia. Radiographically, it may present as a radiolucent uni- or multiocular lesion, normally with well-defined boundaries resembling a "honeycomb" or "soap bubbles". Histologically, it presents various patterns, particularly the multicystic variant. There are various methods of treatment, ranging from enucleation and curettage to the more aggressive resections with or without loss of bone continuity. Being an aggressive tumor, ameloblastoma has a high percentage of recurrence and its prognosis depends on several factors involving clinical, radiological and histopathological features that characterize its biological behavior. The objective of this paper is to report the clinical and radiographic features in the diagnosis of ameloblastoma and the suitable choice of treatment, based on the report of a clinical case... (AU)

Carcinoma in situ in a patient with erythroleukoplakia: challenges in the diagnosis and in the therapeutic choice / Carcinoma in situ in erythroleukoplakia

A 41-year-old Caucasian male smoker presented a red and white plaque on the left jugal mucosa suggestive of oral erythroleukoplakia (OEL). Biopsy followed by microscopic examination revealed carcinoma in situ. Since OEL is considered a precancerous lesion with a high malignant transformation potential, the present case set out to discuss the challenges in diagnosing the condition and choosing the most appropriate treatment. The discussion deals with issues such as whether there is a limit for choosing either a radical or a more conservative approach to treatment and the importance of using a procedure that allows a microscopic examination of the entire lesion. Carcinoma in situ associated with OEL made the treatment planning even more complex in the present case. In order to avoid a mutilating approach, multiple excisions with safety margins were performed, and the patient was instructed not to smoke. A strict 12-month follow-up shows no signs of recurrence of the OEL... (AU)

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS: We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS: The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION: Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica. .

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss / Influência dos corticosteroides no prognóstico auditivo da perda auditiva neurossensorial súbita idiopática

INTRODUCTION: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature. OBJECTIVE: To analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL. METHODS: Observational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL. RESULTS: The absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%. CONCLUSION: In this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis. .

INTRODUÇÃO: A perda auditiva neurossensorial súbita idiopática (PANSSI) é definida pela queda dos limiares auditivos tonais de, pelo menos, 30 dB em três frequências contíguas em até 72 horas e apesar de uma investigação apropriada, a etiologia da lesão não é encontrada. Diversos tipos de tratamentos já foram idealizados para a PANSSI, no entanto, os corticosteroides são os que encontram as melhores evidências de efetividade na literatura. OBJETIVO: Avaliar se o tipo de tratamento e o tempo de demora em iniciar o tratamento com corticosteroides têm correlação com a melhora dos limiares auditivos na PANSSI. MÉTODOS: Estudo de coorte retrospectivo observacional. Foram avaliados 127 pacientes com PANSSI provenientes do ambulatório entre os anos de 2000 e 2010. Foi avaliada a correlação prognóstica do tipo de tratamento e tempo de demora para o início de tratamento e a PANSSI. RESULTADOS: As taxas de recuperação absoluta e relativa foram 23,6 dB e 37,2% respectivamente. Apresentaram melhora completa 15,7% dos pacientes, 27,6% apresentaram melhora significativa e 57,5% melhora. CONCLUSÃO: Neste estudo, não houve diferença entre o uso ou não de corticosteroide na melhora auditiva. Contudo, quando iniciado até sete dias, o uso de corticosteroide foi fator de melhor prognóstico. .

Characterization of an acidification and equalization tank (AET) operating as a primary treatment of swine liquid effluent

This work evaluated the potential of the acidification equalization tank (AET) used as a primary treatment unit, treating the hog farming wastewater. The treatment system consisted of a degritter with a triangular-notch weir, for measuring the flow, a static sieve, and an acidification and equalization tank (AET), an anaerobic baffled reactor (ABR), an upflow anaerobic sludge blanket (UASB) reactor, a settling tank, a greenhouse for fertirrigation and two infiltration ponds. The AET had a net capacity of 8,000 liters, internally covered with asphalt blanket, worked based on surface loading rates application. The unit operated continuously, with its flow varying from 0.1 to 10 L s-1. To determine the efficiency, the following parameters were measured: pH; COD; BOD; volatile and fixed solids; settleable solids; total, intermediate and partial alkalinity and total acidity. The COD removal varied from 5 to 20%. The average pH was 7.3 and the total, intermediate and partial alkalinity in the effluent, were 1919, 846, 1197 mg L-1, respectively. The total acidity in the effluent was 34 mg L-1. The influent and effluent total BOD and oil & grease concentrations were 3436 and 3443 mg L-1, and 415 and 668 mg L-1, respectively. It was found that the AET worked properly concerning the acidification, equalization and sedimentation processes, confirming low cost of implementation and easy operation, when compared to other traditional decanters.

Câncer de cabeça e pescoço: causas, prevenção e tratamento / Head and neck cancer: causes, prevention and treatment

Câncer de cabeça e pescoço é o quinto tipo de câncer mais comum e a taxa de sobrevivência não tem mudado nos últimos anos. OBJETIVO: Determinar os fatores de risco, causas, tratamento e prevenção do câncer de cabeça e pescoço. MÉTODO: Nós detalhamos os fatores de risco, causas, tratamento e prevenção da doença por meio de pesquisa nos bancos de dados PUBMED, MEDLINE e SciELO. RESULTADOS: Álcool e fumo ainda são os principais fatores de risco. Outros fatores podem influenciar o desenvolvimento do carcinoma de cabeça e pescoço. A opção de tratamento principal é terapia cirúrgica e sua utilização seguida por radioterapia é uma prática comum de tratamento em fases iniciais da doença. Existem terapias que visam agir em componentes moleculares genéticos específicos para o desenvolvimento do tumor. A cessação do cigarro, limitação de ingestão de álcool, evitar a exposição à fumaça do cigarro, a carcinogênicos ambientais, detecção precoce de infecção por HPV, manutenção da saúde bucal, bons hábitos alimentares e controle do stress podem ser medidas de prevenção da doença. CONCLUSÃO: Investigações adicionais são necessárias para completa compreensão do desenvolvimento do carcinoma de cabeça e pescoço e isso irá fornecer novos caminhos e melhora na intervenção e abordagens terapêuticas.

Although head and neck carcinoma ranks fifth among cancer types, patient survival rates have not changed significantly over the past years. OBJECTIVE: To determine the risk factors, causes, therapies, and prevention measures for head and neck cancer. METHOD: Risk factors, causes, therapies, and preventive measures for this disease were searched on databases PUBMED, MEDLINE, and SCIELO. RESULTS: Alcohol and tobacco are still atop risk factors. Other factors may influence the development of head and neck carcinoma. Surgery is the main treatment option, and the addition of radiotherapy following surgery is frequent for patients in the early stages of the disease. Other therapies target specific genetic molecular components connected to tumor development. Disease preventive measures include smoking cessation, limiting alcohol intake, preventing exposure to tobacco smoke and environmental carcinogenic agents, early detection of infection by HPV, maintaining oral health, good eating habits, and managing stress. CONCLUSION: Additional research is needed for a more thorough understanding of the development of head and neck carcinomas and to shed light on new ways to improve therapeutic approaches and interventions.

Autologous stem cell transplantation as first line treatment after incomplete excision of pancreatoblastoma

Pancreatoblastoma is a rare tumor and surgery with complete resection is the main treatment approach. Prognosis for patients with residual disease after surgery is usually dismal. A 14-year-old girl with pancreatoblastoma in the pancreatic body and tail was submitted to preoperative chemotherapy. She underwent surgery and the tumor was resected with microscopic margins. Postoperative chemotherapy was followed by high dose chemotherapy and autologous hematopoietic stem cell transplantation. After four years she remains very well with no evidence of disease. This is the first case reported of pancreatoblastoma that was treated with autologous hematopoietic stem cell transplantation as first line treatment without radiotherapy at the site of the microscopic disease.

Uso de ondas de alta frequência no tratamento de onicomicose: comunicação preliminar de três casos / The use of high frequency waves to treat onychomycosis: preliminary communication of three cases

A pesquisa avaliou a eficácia de ondas de alta frequência, no tratamento de onicomicose em 3 pacientes, durante 12 meses, através do exame clínico das unhas e exame micológico. O agente causal da micose nos três pacientes foi o dermatófito Trichophyton rubrum, e, após a aplicação da alta frequência, foi possível observar uma grande melhora no aspecto das unhas e uma inibição do crescimento em cultura, apesar do micológico direto se manter positivo. O estudo preliminar dos três casos demonstrou a atividade fungistática das ondas de alta frequência sendo um método promissor para ser utilizado, em associação com fármacos convencionais.

The research evaluated the efficacy of high frequency waves in the treatment of onychomycosis in three patients during twelve months through the clinical examination of nails and also through mycological examination. The causative agent of the mycosis, in the three patients, was the dermatophyte Trichophyton rubrum and after application of high frequency, it was possible to notice a great improvement in the appearance of nails and also growth inhibition in culture despite the fact that the mycological examination remained positive. The preliminary study of the three cases demonstrated that the fungistatic activity of high frequency waves is a promising method to be used in combination with conventional drugs.

Tratamento após primeiro episódio de luxação traumática do ombro: revisão da literatura / Treatment after a first traumatic anterior dislocation of the shoulder: literature review

Objetivo: O objetivo desta revisão é descrever os achados publicados sobre o manejo no tratamento de pacientes após primeiro episódio de luxação traumática anterior do ombro. Métodos: Elaboramos uma busca ampla na literatura por meio de filtros e estratégia de associação boleana dos termos ?primeiro episódio luxação ombro? e ?tratamento para a identificação de estudos?. Incluímos as bases de dados LILACS e Medline. A partir da identificação consensual dos estudos, procedeu-se a leitura integral de todos os artigos selecionados e subsequente análise dos estudos. Resultados: Através da busca sistematizada nas bases de dados previamente citadas foram encontrados 262 estudos com os termos selecionados. Destes, foram utilizados no desenvolvimento deste artigo de revisão 66 estudos, sendo 64 da base Medline e 2 trabalhos pertencentes a LILACS. Conclusão: A literatura disponível suporta o tratamento cirúrgico precoce após o primeiro episódio de luxação traumática do ombro para jovens atletas do sexo masculino envolvidos em atividades físicas altamente exigentes. No entanto, novos ensaios clínicos de boa qualidade, comparando o tratamento cirúrgico versus não cirúrgico de lesões bem definidas, são necessários, especialmente para as categorias de pacientes que têm um menor risco de recorrência.

Pioderma Gangrenoso: apresentação clínica de difícil diagnóstico / Pyoderma gangrenosum: a clinical manifestation of difficult diagnosis

Pioderma gangrenoso é uma dermatose cutânea ulcerativa incomum, associada a uma variedade de doenças sistêmicas, incluindo doença inflamatória intestinal, artrites, neoplasias hematológicas, hepatites e aids. A sua patogênese é desconhecida. O diagnóstico geralmente é baseado em evidências clínicas e confirmado com a exclusão das outras etiologias de lesões ulceradas cutâneas. Relatamos um caso de PG com ulcerações extensas com boa resposta ao tratamento.

Pyoderma gangrenosum is an uncommon ulcerative cutaneous dermatosis associated with a variety of systemic diseases including inflammatory bowel disease, arthritis, hematological malignancies, hepatitis and acquired immunodeficiency syndrome (AIDS). The pathogenesis of pyoderma gangrenosum remains unknown. Its diagnosis is usually based on clinical evidence and confirmed through a process of elimination of the other possible causes of cutaneous ulcers. This report describes a case of pyoderma gangrenosum with extensive ulceration that responded well to treatment.

Osteoma mastoideo: considerações sobre dois casos e revisão da literatura / Mastoid osteoma: consideration on two cases and literature review

Introdução/Objetivo: Osteoma da mastoide é um tumor osteogênico benigno, considerado raro nesta localização. Até o ano de 2006 havia cerca de 150 casos relatados na literatura médica. Na sua etiopatogenia incluem fatores relacionados com a embriogênese, metaplasia, trauma e inflamação. Geralmente são assintomáticos e manifestam-se através de tumoração protruindo da região retroauricular. Tomografia computadorizada tem sido útil no seu diagnóstico e planejamento cirúrgico. Seu resultado cirúrgico é bom do ponto de vista estético e curativo. Método: Foram estudados dois casos de osteoma mastoideo e analisados quanto ao seu quadro clínico, exames de imagens, tratamento e resultados. Resultados: Ambos localizados na região mastoidea direita. Ausência de história de trauma prévio nesta região. Exame neurológico normal. Tomografia computadorizada craniana revelou lesão hiperdensa envolvendo a córtex do osso temporal na região mastoidea, compatível radiologicamente com osteoma. Foram submetidos à exérese total da lesão. Exame anatomo-patológico: Osteoma. Apresentaram resultados estéticos e curativos excelente. Não houve recidiva ou transformação maligna. Conclusões: O osteoma localizado na região mastoidea é um tumor benigno raro. Provoca deformidade estética local. Geralmente é assintomático. O exame de eleição é a tomografia computadorizada. Apresenta diagnóstico diferencial com hemangioma, displasia fibrosa, osteosarcoma e metástase osteoblástica. Não apresenta transformação maligna. Seu tratamento é cirúrgico e com resultados estéticos e curativos excelente.

Introduction/Objective: The mastoid osteoma is a benign osteogenic tumor, considered to be uncommon in such location. By 2006, there were about 150 cases reported in the medical literature. Its etiopathogenesis includes factors relating to embryogenesis, metaplasia, trauma and inflammation. They are generally asymptomatic and appear through tumoration protrusion from the retroauricular region. Computed tomography has been useful for its diagnosis and surgical planning. Its surgical results are good from a aesthetic and curative point of view. Method: We studied two cases of mastoid osteoma and analyzed them as for their clinical state, imaging exams, treatment and results. Results: Both locating in the right mastoid region. Absence of a previous trauma in this region. Normal neurological exam. The cranial computed tomography revealed a hyperdense lesion involving the cortex of the temporal bone in the mastoid region, radiologically compatible with osteoma. They were submitted to complete exeresis of the lesion. Anatomopathological exam: osteoma. They had excellent aesthetic and curative results. There was no recurrence or malignant transformation. Conclusions: The osteoma located in the mastoid region is an uncommon benign tumor. It provokes local aesthetic deformity and is generally asymptomatic. The choice exam is computed tomography. It has a differential diagnosis with hemangioma, fibrous dysplasia, osteosarcoma and osteoblastic metastasis. The exam does not present malignant transformation. The treatment is surgical and with excellent aesthetic and curative results.

Weight gain, dyslipidemia and altered parameters for metabolic syndrome on first episode psychotic patients after six-month follow-up

OBJECTIVES: Obesity and metabolic abnormalities are frequent in psychotic patients, including first-episode psychosis. We evaluated weight and metabolic parameters in first-episode psychotic outpatients from the First Episode Psychosis Program, Universidade Federal de São Paulo. METHOD: Weight, height, waist and hip circumferences, glucose and lipid levels were measured at baseline and after a six-month period. RESULTS: Fifty-seven patients were included and 44 (77.2 percent) of them finished the study. Patients had a median age of 26.3 years, 60 percent were men and 43 percent had a diagnosis of schizophrenia at the endpoint. Weight and BMI values increased significantly during the follow-up (p < 0.01). The average weight gain at the follow-up was 10.1 percent of the baseline weight (SD = 11.9). Only women presented significant waist abnormalities: at the first assessment the waist mean was 79.12 cm (SD = 10.68) and 6 months later it had increased to 89.65 cm (SD = 11.19, z = -3.182, p = 0.001). After 6 months, the total cholesterol (p = 0.004), and triglyceride levels (p = 0.016) increased, while HDL-cholesterol levels decreased (p = 0.025). During the follow-up period one patient (2.3 percent) developed diabetes mellitus, one (2.3 percent) presented altered fasting glucose, 12 (27.2 percent) patients developed at least two altered parameters for metabolic syndrome and 3 (6.8 percent) patients developed metabolic syndrome (p = 0.001). DISCUSSION: The results of this study showed that in a short period of time individuals under antipsychotic treatment had their weight increased significantly and developed important metabolic abnormalities. CONCLUSIONS: Clinicians should be aware of these risks, choose an antipsychotic that causes less weight gain and should monitor these patients carefully, and recommend prophylactic measures as diet restriction and physical activities.

OBJETIVOS: Obesidade e alterações metabólicas são freqüentes em pacientes psicóticos, inclusive no primeiro episódio psicótico. Foram avaliados peso e parâmetros metabólicos em pacientes em tratamento no Programa de Episódio Psicótico da Universidade Federal de São Paulo. MÉTODO: Peso, altura, medida de cintura e quadril, glicemia e perfil lipídico foram avaliados no início do tratamento e após seis meses. RESULTADOS: Cinqüenta e sete pacientes foram incluídos no estudo e 44 (72 por cento) concluíram o estudo. Os pacientes apresentavam em média 26,3 anos, 60 por cento eram do sexo masculino e, ao final do estudo, 43 por cento apresentavam diagnóstico de esquizofrenia. Houve aumento significativo do peso e índice de massa corporal durante o estudo (p < 0,01). Em média, o peso aumentou 10,1 por cento do peso inicial (SD = 11,9). Apenas mulheres apresentaram alterações na medida da cintura: no início, a média da cintura era de 79,12 cm (SD = 10,68) e, após seis meses, houve um aumento para 89,65 cm (SD = 11,19, z = -3,182, p = 0,001). Após seis meses, houve aumento do colesterol total (p = 0,004) e triglicérides (p = 0,016), e diminuição dos níveis de colesterol HDL (p = 0,025). No período, um paciente (2,3 por cento) desenvolveu diabetes mellitus, um paciente (2,3 por cento) apresentou glicemia de jejum alterada, 12 (27,2 por cento) desenvolveram pelo menos dois parâmetros alterados para síndrome metabólica, e 3 (6,8 por cento) apresentaram síndrome metabólica (p = 0,001). DISCUSSÃO: Os resultados deste estudo mostram que em um curto período de tempo pacientes em tratamento com antipsicóticos aumentaram substancialmente o peso e desenvolveram importantes alterações metabólicas. CONCLUSÃO: Os clínicos devem estar atentos a esses riscos, escolher medicações que causem menor ganho de peso, devendo monitorar esses pacientes cuidadosamente e recomendar medidas profiláticas como restrição dietética e atividade física.